Senior Coding Specialist-Inpt

  • Requisition ID: 179227
  • Department: 100738 Facility Coding
  • Schedule: Full Time - Eligible for Benefits
  • Shift: Varies
  • Category: Administrative Support Workers

Position Purpose:

The purpose of this Master level coding position is to accurately assign diagnostic and procedural coding relative to revenue and facility reimbursement for all patient type encounters and is proficient and knowledgeable in all aspects of facility coding. This list may include a combination of Acute Inpatient, Level II Trauma, Rehab Facility, Skilled Nursing, Home Health as well as Hospice.  ICD-9-CM/ICD-10-CM/PCS and CPT code assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines. 

Nature and Scope:

Incumbent will also be responsible for addressing RAC and related payer denials and reviews. Coding of highly complex medical records as well as medical record review. This class differs from a Level 2 in that addressing review and focused auditing when needed is distinctive; knowledge and skill level is greater.  Supervision is not a responsibility of this position, however technical guidance and acting in a mentoring educational role is expected when appropriate.

 

Incumbent must have skill set to:

·         Addresses appeals and review documentation needed for insurance denials to facilitate expedient resolution and reimbursement.

·         Participates in mandated Medical Record Review processes.

·         Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.

·         Identifies and analyzes patterns in possible coding errors or other trends to report to Coding Leadership, Coding Leads and/or Coding Auditor.

·         Ensures that all factors necessary for assigning accurate DRG are present, and that related diagnoses are ranked properly.

·         Assign accurate present on admission indicators.

·         Provides information and responds to inquiries regarding medical documentation and DRG’s to CDI staff including Utilization and Quality Assurance Departments when needed.

·         Knowledge of discharge disposition and reimbursement outcomes.

 

To appropriately and accurately translate diagnoses, contact with appropriate charging departments and healthcare providers may be required to acquire or clarify necessary information.

 

Incumbent  must be knowledgeable in Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed. Job responsibilities include assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided. When documentation is incomplete, vague, or ambiguous, it is the responsibility of incumbent to work in conjunction with department Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable sign, symptom, or diagnosis and/or physician order.  Other responsibilities include:

·         Adherence to Health Information Management (HIM) Coding policies.

·         Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy.

·         Responsibility for maintaining coding certification and referencing current ICD-9/ ICD-10 coding guidelines and regulatory changes.

·         Participates in performance improvement initiatives as assigned.

This position will also be involved in collaboration and teamwork with Clinical Documentation Improvement Department.

 

The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.

 Telecommuting is allowed with approval from HIM Management.

 

KNOWLEDGE, SKILLS & ABILITIES

 

1.       Knowledge of Anatomy and Physiology, Disease Pathology, Pathophysiology, Pharmacology and Medical Terminology.

2.       Knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS’  Official Guidelines for Coding and Reporting  ICD-9-CM/ ICD-10-CM coding.

3.       Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-9-CM/ ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.

4.       Knowledge of clinical content standards.

This position does not provide patient care.

The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications:  Requirements - Required and/or Preferred

Education:

Must have working-level knowledge of the English language, including reading, writing and speaking English.   Bachelors Degree in Health Information Management is preferred.

Experience:

A minimum of 4 or more years of progressively responsible and advanced experience in healthcare coding. Experience in all patient types as well as experience and knowledge of needed compliance criteria for all facility types is required.

License(s):

None

Certification(s):

CCS is required.  

Computer / Typing:

Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

Benefits

Renown Health exists to make a genuine difference in the health and well-being of the people and communities we serve. And it is through your passion that this mission is made real every day. The relationship with employees is the foundation for success as we proceed with our strategic direction. We strive to build upon this solid partnership by offering a comprehensive and competitive benefits package that meets the diverse needs of employees and their family members.

With my CAREER Rewards there's peace of mind in knowing that Renown Health is also fighting for the most important things in your life - family, finances and future. Navigate options and make sure you are getting the most value from your Nursing career with us.

  • Icon- Edu Assistance@1x

    Education Assistance

  • Icon - PTO@1x

    Paid Time Off

  • Icon - 401@1x

    401(k) Company Match

  • Icon - Flexible Env@1x

    Flexibile Work Environment