Full time
Day Shift
Provides high level technical competency and subject matter expertise analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Medicare Severity Diagnosis Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC), Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, MS-DRG, APR DRG, POA, SOI & ROM assignments.
ESSENTIAL FUNCTIONS:
1. Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.
2. Navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
3. Codes Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators
Reviews Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.
5. Works Inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
6. Adheres to Inpatient coding quality and productivity standards established by Revenue Excellence/HM.
7. Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
8. Utilizes EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.
9. Works with HIM and Patient Business Services (PBS) teams, when needed, to help resolve billing, claims, denial, and appeals issues affecting reimbursement.
10. Maintains CEUs as appropriate for coding credentials as required by credentialing associations.
11. Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for Inpatient coding e.g., Hospital at Home.
12. Identifies, and attempts to problem solve, coding and/or EMR workflow issues that can impact coding.
13. Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.
14. Performs other duties as assigned by Leadership.
15. 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
MINIMUM QUALIFICATIONS:
1. Completion of an AHIMA-approved coding program or Associate’s degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.
2. Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) is required.
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3. Three (3) years of current acute care or Inpatient coding experience is required. Extensive, comprehensive working knowledge of medical terminology, Anatomy and Physiology, diagnostic and procedural coding and MS-DRG, APR DRG assignment. Must be proficient on identifying POA, SOI and ROM indicators for Inpatient records as well as HACs and PSIs to ensure accurate hospital reimbursement.
4. Current experience utilizing encoding/grouping software and Computer Assisted Coding (CAC) is preferred.
5. Ability to use a standard desktop/laptop, email, and other Windows applications, if needed, Internet and web-based training tools preferred.
6. Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.
7. Ability to research, analyze and assimilate information from various
Hourly Pay Range: $27.41 - $ 41.13
Our Commitment
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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