Inpatient Lead Coder

POSITION SUMMARY:

Assigns appropriate codes to reflect all diagnoses and procedures extrapolated from physician and appropriate nursing documentation during a patient encounter according to the most current coding methodologies, including ICD-10-CM/PCS, resulting in appropriate reimbursement. Abstracts required data to input into the Medical Center's computerized data base. Converts all patient visits and encounters into appropriate DRG (Diagnosis Related Group) assignments in order to correctly submit the optimal reimbursement for each patient encounter coded. Assists the IP Coding Manager in administrative duties such as assignment of coding work, analysis of the unbilled report, and other duties as assigned.

Position : Inpatient Lead Coder

Department : Clinical Documentation

Schedule : Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

Abiding by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adhering to official coding guidelines and departmental procedures, the Team Leader, IP Coder:

• Assists IP Coding Manager with assignment of work to Coders, analysis of the daily unbilled report, and follow-up on unanswered physician queries and missing documentation.

• Assists PFS in researching unbilled accounts and updating incorrect discharge dispositions.

• Assists Coding Manager in orienting, training, and mentoring staff, provides ongoing education as needed.

• Assists IP Coding Manager as a resource and subject matter expert to outside departments.

• Assists IP Coding Manager trouble shooting system issues with 3M encoder and EPIC.

• Assists IP Coding Manager with special projects as needed.

• Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures.

• Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM/PCS classification systems.

• Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing.

• Sequences diagnoses, procedures and complications by following ICD-10-CM/PCS and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate.

• Consults with the CDCI team to request appropriate physician or appropriate medical staff to clarify medical record information.

• Assigns grouper codes to each record according to patient type and financial class.

• Enters coded/abstracted information in grouper, analyzes groupings, and assigns the appropriate grouper for appropriate and accurate reimbursement.

• Data enters abstracted information into the Medical Center's computerized database.

• Maintains coding accuracy rate of 95% or better.

• Maintains productivity standards set forth in Departmental Policies and procedures.

• Coordinates with HIM to track missing provider documentation so that all records can be coded and billed in a timely fashion.

• Maintains professional skills and knowledge of coding through attendance at in-service programs, conferences, workshops and other educational programs and review of current literature.

• Assist in orienting new personnel to department coding procedures.

• Serves as resource for the Revenue Cycle Analysts in working claims in scrubber to clear for billing.

• Utilizes hospital’s behavioral standards as the basis for decision making and to facilitate the hospital’s goals and mission.

• Follows established Hospital infection control and safety procedures.

• Performs other duties as needed.

(The above statements in this job description are intended to depict the general nature and level of work assigned to the employee(s) in this job. The above is not intended to represent an exhaustive list of accountable duties and responsibilities required).

JOB REQUIREMENTS

EDUCATION:

• Level of knowledge equivalent to that ordinarily acquired through completion of an Associate's Degree in Health Information, Medical Records or similar program.

• An equivalent combination of education and experience, which provides proficiency in the areas of responsibility, may be substituted for the stated education and experience requirements.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED :

• Requires inpatient CCS, RHIT or RHIA credentials from AHIMA

• CCS coding credential requires inpatient coding experience before taking exam

• RHIT and RHIA must have associate’s and bachelor’s degree respectively before taking exam

EXPERIENCE:

• Minimum of five years inpatient coding experience in a Level 1 Trauma, Teaching Facility

KNOWLEDGE AND SKILLS:

• Work requires in-depth knowledge of medical terminology, ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs, AP-DRG, and APR-DRGs). Work also requires basic concepts of human anatomy, physiology and pathology.

• Experience with ICD-10-CM/PCS for diagnoses and procedures

• Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.

• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.

• Ability to work with accuracy and attention to detail

• Ability to solve problems appropriately using job knowledge and current policies/procedures.

• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.

• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

• Solid (or could use excellent again) communication skills, both oral and written.

Compensation Range:

This range offers an estimate based on the minimum job qualifications. However, our approach to determining base pay is comprehensive, and a broad range of factors is considered when making an offer. This includes education, experience, skills, and certifications/licensures as they directly relate to position requirements; as well as business/organizational needs, internal equity, and market-competitiveness. In addition, BMCHS offers generous total compensation that includes, but is not limited to, benefits (medical, dental, vision, pharmacy), discretionary annual bonuses and merit increases, Flexible Spending Accounts, 403(b) savings matches, paid time off, career advancement opportunities, and resources to support employee and family well-being.

NOTE : This range is based on Boston-area data, and is subject to modification based on geographic location.

Equal Opportunity Employer/Disabled/Veterans

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