Coding Specialist Jobs

About The Position

Requirements

• High school diploma or GED equivalent.
• Five years of progressively responsible and directly related work experience.
• Successful completion of the pre-hire Coder Proficiency Exam.
• One of the following certifications: RHIA, RHIT, or CCS.
• Ability to apply AHIMA's Code of Ethics and Standards and UHDDS standards.
• Ability to use ICD-10-CM/PCS and CPT-4 coding conventions, read and abstract medical records, and assign accurate codes for MS-DRG and APR-DRG grouping.
• Knowledge of MS-DRG and APR-DRG grouping schemes, health information systems, CCI and CMS compliance issues, and relevant computer systems and software.
• Knowledge of medical record standards and regulations, coding systems, medical terminology, anatomy and physiology, and diseases.
• Ability to plan, organize, prioritize, multitask, adapt to change and ambiguity, work independently, and meet deadlines.
• Ability to solve technical and non-technical problems and exercise critical thinking, judgment, and decision-making.
• Ability to establish effective working relationships, build consensus, and work effectively with people at all organizational levels.
• Strong written and oral communication skills.

Responsibilities

• Review inpatient medical record documentation and assign accurate ICD-10 diagnosis and procedure codes, including codes leading to the appropriate MS-DRG or APR-DRG.
• Verify patient discharge disposition, assign admission sources for state reporting, and apply present-on-admission indicators.
• Abstract required data according to facility specifications.
• Monitor Discharged Not Billed accounts and help ensure timely, compliant processing of inpatient accounts through the revenue cycle.
• Collaborate with Clinical Documentation Specialists and medical staff to address documentation completeness and support appropriate coding and DRG assignment.
• Maintain established accuracy, quality, and productivity standards.
• Stay current with CMS requirements, CCI edits, HACs, PSIs, and applicable NCDs and LCDs, including appropriate modifiers to support clean claims.
• Use coding, audit, clinical documentation, abstracting, and other software tools and reference materials to validate information.
• Follow Stanford Health Care policies and procedures, official coding guidance, and ethical coding standards.
• Attend required meetings and educational sessions and complete annual learning programs.