Coder III : Medical Coding

Primary Duties And Responsibilities

• The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes to support diagnoses, procedures, and treatment results.
• Codes are used for billing, internal and external reporting, research, and regulatory compliance activities.
• Abides by the standards of Ethical Coding as set forth by the American Health information Management Association (AHIMA) and adheres to all official coding guidelines.
• Verifies that all ICD-10-CM and CPT codes are correctly captured.
• Verifies that physician is correctly abstracted.
• Keeps abreast of coding guideline changes by self-study, assigned education, coding meeting attendance or related in-services.
• Participates in internal and external quality review meetings.
• Performs other duties as assigned.

Medical Coding - Hoag Hospital

• Solves billing related errors and assists with workflow changes and process improvement projects.
• Maintains a productivity and quality standard of 95% accuracy rate or better.
• Assigns codes for diagnoses, treatment, and procedures for inpatient surgeries.
• Determines the correct principal diagnosis, co-morbidities, complications, secondary conditions, and surgical procedures.
• Abstracts correctly all required information from record including the correct discharge disposition and OSHPD required information.
• Affixes correct MS-DRG and APR-DRG and correct Present on Admission (POA) indicators and identifies (HAC) Hospital Acquired Conditions.
• Queries physicians per established policy and procedure when documentation is not clear or conflicting.

Coding - Hoag Clinic

• Maintains a productivity and quality standard of 95% accuracy rate or better.
• Fulfills coding conventions and serves as a coding consultant to Hoag providers.
• Identifies discrepancies that may impact quality of care and/or billing issues.
• Serves as a resource and subject matter expert to other coding staff.
• Completes coding charge review and claim edits in Epic or other appropriate EMR system which would entail coding and correcting ICD-10 codes, modifiers, and CPT E/M and procedure codes.
• Reviews and communicates with providers on E/M Leveling/Coding.
• Codes specialty specific outpatient surgeries/same day procedures.

Qualifications

• Education and Experience:
  • High school diploma or equivalent required.
  • Completion of a certified coding program or graduate of a CAHIM accredited HIT program required.
  • Five years of progressive inpatient coding experience in an acute care facility.
  • Five or more (5+) years coding experience mastering assigning diagnostic and procedure codes to patient medical records.
  • Must have extensive outpatient coding experience in multiple areas of specialty.
  • To include but are not limited to: OB/GYN, Urology, Oncology, Pain Management, Cardiology, Neurology, and Orthopedics.
  • Knowledge of E/M coding related to multi-specialty providers.
  • Knowledge of the elements of disease processes and related procedures.
  • Strong clinical knowledge and understanding of pathology / physiology of disease processes.
  • Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff and hospital management staff with the ability to facilitate ongoing physician communication and able to work independently in a time-oriented environment.
  • Experience working in EPIC- EMR.
• Licenses and Certifications:
  • N/A
  • N/A
  • Required: Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Coding Specialist Physician-Based (CCS-P), Certified Coding Specialist (CCS), Certified Professional Medical Auditor (CPMA).
  • Preferred: Certified Urology Coder (CUC).

About Us

Hoag Memorial Hospital Presbyterian is a nonprofit regional health care delivery network in Orange County, California, consisting of three acute-care hospitals with sixteen urgent care centers, eleven health centers and a network of more than1,800 physicians, 100 allied health members, 8,000 employees, and 2,000 volunteers. More than 30,000 inpatients and 550,000 outpatients choose Hoag each year. For over 70 years, Hoag has delivered a level of personalized care that is unsurpassed among Orange County’s health care providers. Since 1952, Hoag has served the local communities and continues its mission to provide the highest quality health care services through the core strategies of quality and service, people, physician partnerships, strategic growth, financial stewardship, community benefit and philanthropy. Hoag offers a comprehensive blend of health care services including six institutes providing specialized care in the areas of cancer, heart and vascular, neurosciences, women's health, orthopedics, and digestive health through our institutes. Hoag was the highest ranked hospital in Orange County in the 2024-2025 U.S. News &World Report, the only Orange County hospital ranked in the top 10 for California. The organization was ranked the #5 hospital in the Los Angeles Metro Area and the #10 hospital in California. To learn more about Hoag’s awards and accreditations, visit: https://www.hoag.org/about-hoag/awards-accreditations/.

Hoag is an Equal Opportunity Employer and prohibits discrimination and harassment of any kind. Hoag is committed to the principle of equal employment opportunity for all employees and providing employees with a work environment free of discrimination and harassment. Hoag hires a diverse group of people in a manner that allows them to reach their full potential in the pursuit of organizational objectives.