Job DescriptionJob Summary:
Reviews inpatient records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including inpatient encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work.
Job Requirements:
Education and Work Experience:
- High School Education/GED or equivalent: Required
- Working knowledge of hospital Cerner EMR (electronic medical record) and of ICD-10-CM and ICD-10-PCS Codes: Required
- Five years' inpatient coding experience: Required
- Experience in a health care setting: Required
Licenses/Certifications:
- AHIMA Certified Coding Specialist (CCS): Required
Essential Functions:
- Reviews MS-DRG, APR-DRG and payor denials and provides feedback to leadership and other departments including patient financial services and quality. Performs inpatient audits including payor audits, discharge dispositon audits and overall coding accuracy audits. Maintains denial and other spreadsheets for assigned denial and audit duties. Attends mortality meetings and provided coding feedback. Provide input and feedback to clinical documentation integrity and quality departments for DRG mismatches. Researches and provides feedback and direction to inpatient coding associates. Ensures coding corrections and edits are updates. Keeps abreast of regulatory changes related to coding and documentation and communicates these updates and changes to coding and leadership. Provides edicational sessions and training resources to coding associates. Assists leadership and coding with reaching departmental metric goals. Abstracts and assigns ICD-10-CM diagnosis codes and PCS codes from the inpatient patient record to ensure accurate MS-DRG and APR-DRG assignment and to provide information required for reimbursement and statistical data submissions. Understands MS-DRG and APR-DRG methodologies. Generates compliant physician queries. Work with clinical documentation integrity and quality departments to identify HAC/PSI and communicate issues affecting inpatient records.
- Validates appropriate dates of service against documentation in the EMR for inpatient encounters. Completes required abstract fields in registration conversation on inpatient encounters for OSHPD and other data submissions. Communicate with appropriate departments related to charge corrections/modifications. Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory agencies. Follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. Reviews, understands and applies quarterly coding clinics, coding guidelines and coding converntions of ICD-10-CM references. Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accurateness of documentation and physician coding practices. Analyzes content of reports and software edits to facilitate revisions with appropriate departments - NCCI edits.
- Follows up coding holds, revenue cycle department holds including related and all other email communication.
- Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accuracy of documentation and physician coding practices. Maintains required online Healthstream education courses.
- Attends meetings and training pertaining to coder education, audit reviews, staff meetings, and inpatient coder roundtable meetings.
- Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
