Coder/Abstractor III (Remote, WA residents only) (2025-1426)

Job Overview

The position involves hospital inpatient coding and abstracting based on documentation and coding guidelines within established productivity standards for all accounts assigned. It also includes resolving coding related edits and denials, providing feedback and education to physicians and clinicians, and following up on accounts unable to code due to missing/incomplete documentation or charges.

Qualifications

• Associate or bachelor's degree in HIM, required.
• RHIA, RHIT, or CCS required.
• 3 or more years exclusively in inpatient hospital coding experience, required.
• Demonstrated advanced ability to use and understand DRG, ICD-10-CM, and ICD-10-PCS coding methodologies.
• Advanced knowledge of anatomy, physiology, pharmacology, disease processes and medical terminology.
• Ability to communicate in writing and verbally in the English language in an effective manner.
• Excellent customer service skills, including telephone interactions.
• Proficient data entry skills.
• Prominent ability to interact with physicians and support staff.
• Attention To Detail And Excellent Organizational Skills Are Essential.
• Knowledge of Medicare, Medicaid, and third-party coding and billing requirements.
• Successful completion or pre-hire coding test.

Performance Responsibilities

• Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG).
• Maintains confidentiality of protected health information.
• Reviews coding-based edits, corrects errors, and educates clinic and medical staff on appropriate use of ICD-10-CM and ICD-10-PCS codes.
• Demonstrate advanced competency with ICD-10-CM and ICD-10-PCS code assignment for diagnoses and procedures for hospital requirements.
• Collaborates with Clinical Documentation Specialists, HIM deficiency team, and members of the medical staff to ensure completeness of documentation in the charts so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
• Codes all records based on documentation, being careful to follow strict coding guidelines, payer regulations, and ethics.
• Ensures compliance with all Federal and State guidelines regarding correct coding initiatives.
• Mets productivity coding standards as outlined in the productivity policy.
• Participates in coding meetings to enhance knowledge and coding compliance skills.
• Communicates effectively with Revenue Cycle team and hospital departments in relationship to coding or charging concerns and the submission of claims.
• Reviews coding-based payment denials, identifies patterns, corrects errors, and educates clinic and revenue cycle staff on appropriate coding procedures when services are denied due to inappropriate diagnosis or procedure coding.
• Provides immediate telephone support to clinic, medical, and revenue cycle staff who have coding questions.
• Assists with new provider orientation on VMC's coding, audit process and documentation standards.
• Apprises management of concerns as appropriate, including backlogs and time available for additional tasks.
• As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.
• Maintains appropriate CEU's annually as required for certification.
• Adheres to policies and procedures as required by VMC.
• Completes additional projects and duties as assigned.