GENERAL SUMMARY: Ensures proper assignment of diagnosis and procedure codes, along with validating and adjusting charges according to the services the patient received. Works collaboratively with Clinical Documentation Improvement personnel to ensure coding is clinically supported. Participates in the identification and resolution of discrepancies in documentation; assists in training as necessary. Maintains a working knowledge of applicable coding and reimbursement Federal, State, and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior. Participates in quality assessment and continuous quality improvement activities. Performs all job duties and responsibilities in a courteous and customer-focused manner according to the Hurley Family Standards of Behavior.

SUPERVISION RECEIVED: Works under the general supervision of the Clinical Coordinator and/or Director of Coding and Clinical Documentation Improvement (CDI).

MINIMUM ENTRANCE REQUIREMENTS:

• Associate’s Degree in Health Information Management or related field.
• Two (2) years of documented experience in ICD-10-CM and ICD-10-PCS coding and DRG reimbursement.
• Certification through AHIMA in Registered Health Information (RHIA, RHIT) or as a Certified Coding Specialist (CCS); or Certification through AAPC as a Coding Specialist (CIC).
• Demonstrated knowledge of reimbursement methodology pertaining to MS-DRG’s, APR-DRG’s, and APC’s.
• Ability to properly sequence ICD-10 codes based on coding guidelines and coding clinics. Proficient on identifying POA, SOI, and ROM indicators for Inpatient records as well as HAC’s and PSI’s to ensure accurate hospital reimbursement.
• Knowledge of the required content and claim completion guidelines of the UB04.
• Possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting as well as Coding Clinics.
• Demonstrated ability to function in a 100% virtual environment working independently while maintaining efficiency, compliance, and coding quality standards.
• Enhances coding knowledge and skills with continuing education activities and by reviewing pertinent literature.
• Knowledge of professional coding practices.
• Ability to communicate effectively in oral and written modes.
• Ability to interact successfully and maintain harmonious relationships with physicians and Medical Center personnel.

RESPONSIBILITIES AND DUTIES:

1. Assigns diagnostic and procedural codes to patient's clinical records using ICD-10-CM and ICD-10-PCS coding systems for reimbursement purposes and for Hurley Medical Center's automated information system: Responsible for inpatient coding as assigned.
2. Determines DRG assignment through input of diagnostic codes, procedural codes and abstracted data into the computer system: Follows up to ensure accuracy of DRG assignment for cases submitted for reimbursement.
3. Abstracts specific data elements after thorough review of each medical record.
4. Designates principal diagnosis and procedure on complex cases requiring independent action and judgment; assists in monitoring the completeness, accuracy and consistency of the principal diagnosis, related diagnoses and procedures.
5. Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to determine the Principal Diagnosis, secondary diagnoses, and procedures. Screens medical records to ensure completeness in line with record content guidelines such as Present On Admission (POA) indicators and discharge disposition.
6. Identifies discrepancies and inconsistencies in documentation; assignment of codes and abstraction of data elements. Serves as a liaison between other departments in resolving complex problems associated with data entry and submission of diagnostic/procedural codes for reimbursement.
7. Maintains accurate diagnostic and procedural indices and retrieves data from the indices for complex requests from physicians, Administration, Hurley Medical Center personnel and external agencies.
8. Utilizes coding expertise and knowledge to write appeal letters in response to payor disputes related to medical necessity and level of care determinations. Prepares complex routine and special reports relative to the Data Unit.
9. Reviews Claim Edits for coding corrections.
10. Maintains various control functions that enable monitoring of specific status including abstract accounting, batch control and coding status.
11. Demonstrates knowledge of current, compliant coder query practices related to the composition and forwarding of queries to providers.
12. Assists in identifying, developing and implementing new procedures and operational systems designed to increase operating efficiency.
13. Assists in performing quality monitoring for the accuracy and validity of coded and abstracted data; assists in revising coding/abstracting and data collection guidelines to reflect accurate data optimizing hospital reimbursement.
14. Participates in ongoing education and training to remain current with evolving coding standards, medical practices, compliance and technology.
15. May assist in training personnel in the policies and procedures related to proper coding, compliance, and auditing of patient charts.
16. Performs other related duties as assigned. Utilizes new improvements, and/or technologies that relate to work assignment.