Westchester Medical Center Health Network

Job Summary: The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the current International Classification of Diseases (ICD10 CM/PCS codes) and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected. Does related work as required.

Responsibilities:

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures.
• Identifies and analyzes patterns in possible coding errors or other trends and reports to the the coding leadership team.
• Participates in mandated medical record review processes.
• Using current ICD10 CM/PCS coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
• Queries physicians for documentation clarification
• Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly.
• Makes appropriate contacts in order to acquire or clarify necessary information.
• Compiles and updates the appeal log detailing denials, hospital's reply, and follow-up responses.
• Provides information and responds to inquiries regarding medical documentation and DRG'S to hospital staff including Utilization and Quality Assurance staff, Patient Accounts staff and the Risk Manager.
• Abstracts information from medical records to compile reports and statistical information.
• May train lower level coders and provide technical guidance and expertise
• Resolves bill holds in a timely manner to maintain DNFB and maintains coding queue
• Acts as a liason between Patient Accounting and Coding

Qualifications/Requirements:

Experience: Minimum of three years of experience where the primary function of the position must have been inpatient coding in acute care setting.

Demonstrate proficiency in ICD 10 CM and ICD 10 PCS by passing coding assessment administered before hire.

Education: High School or equivalency diploma, required. Satisfactory completion of 30 credits* toward an Associate’s degree or Bachelor’s degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience. There is no substitution for the two years of specialized experience.

Licenses / Certifications: Current certification as a Certified Coding Specialist (CCS) required. Certification as Registered Health Information Administrator (RHIA) or as a Registered Health Information Technologist (RHIT) by the American Health Information Management Association preferred.

Other: Comprehensive knowledge of the American Hospital Association (AHA) Official Coding Guidelines; comprehensive knowledge of the current and ICD10 CM/PCS codes; thorough knowledge of DRG classification systems; thorough knowledge of medical terminology, anatomy and physicology; ability to understand and code medical records; ability to communicate effectively both verbally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar and e-mail for performing work assignments; ability to read, write, speak, understand, and communicate sufficiently to perform the essential duties of the position.