Coder Specialist - Remote

About the role

Reviews, codes, and analyzes medical records in order to abstract relevant data from patient medical records into the on-line computer system. Assigns DRGs to Medicare, Medicaid, and other required payors. Determines DRG and APC assignment on outpatient and inpatient records. Maintains productivity and accuracy levels for the assigned job code.

Responsibilities

• Reviews and analyzes discharged patient medical records to ensure all applicable patient data is available for coding and abstracting by checking the diagnosis and procedure to ensure accurate coding and sequencing as specified by established coding principles and guidelines, following AHA, AHIMA, and CMS coding guidelines for outpatient and inpatient records
• Obtains accurate and complete patient data through the review of the medical record, discharge summary, history and physical, consultation, progress notes, laboratory, radiology, operative and pathology reports
• Codes all procedures on inpatient records (all payors) and outpatient surgical records according to ICD-9-CM Codes, CPT-4 or Physician E&M (Evaluation & Management) Level Code (as applicable)
• Refers questionable diagnoses and sequencing issues to the physician for clarification
• Communicates with the Patient Accounts staff and coordinates with department Manager any questionable abstract or coding problems
• Assigns ICD-9-CM Codes and completing a coding summary
• Reviews and evaluates error messages and all incompatible DRGs to the manager or coordinator for a second level review
• Completes medical records for abstracting
• Resolves any medical necessity related issues
• Completes medical record data entry duties by abstracting diagnosis and procedure codes into the Hospital computer system according to specified guidelines
• Designates APC assignment on outpatient medical records
• Assigns accurately, when applicable, a DRG or APC to Medicare, Medicaid and other required payor's records with the assistance of various computerized grouper software
• Abstracts professional E&M codes, professional procedure codes, and technical component procedures into the Hospital computer system charging module according to specified guidelines
• Accurately and timely entry of charges on ED and OBS charts according to guidelines if applicable
• Ensures accurate and up-to-date coding by quarterly internal and external auditing, reviewing Coding Clinic and attending coding workshops to enhance coding skills, and billing software edits
• For the coding of diagnostic reports, meets a productivity standard of 250 reports (based upon an 8 hour work day) and resolves medical necessity holds
• For the coding of inpatient, ambulatory surgery/observations and emergency records, meets one of the following productivity standards (all include data entry and are based upon an 8 hr work day): Inpatient Records: Certified Specialist (greater than 25); Ambulatory Surgery/Observation Records: Cert Spec (greater than 60); Emergency Records Facility Records: Certified Specialist (greater than 90); Emergency Records Professional Records: Certified Specialist (100-120)
• Performs other functions to maintain personal competence and contribute to the overall effectiveness of the department by completing other job-related duties and projects as assigned

Requirements

• This is a remote position; candidates must reside in one of the following states: Indiana, Michigan, Illinois, Kansas, Ohio, Georgia, Kentucky, Florida, Idaho, Minnesota, Tennessee, Wisconsin, Colorado, South Carolina, North Carolina, or Texas
• The knowledge, skills and abilities as indicated below are normally acquired through the successful attainment of certification as a CCS (Certified Coding Specialist), and maintenance of the certification is required
• Designation as a Certified Specialist requires the completion of course work in medical terminology, anatomy, physiology and comprehensive knowledge of ICD-9-CM and CPT-4 coding principles
• Attainment of certification as either RHIT (Registered Health Information Technician), RHIA (Registered Health Information Administrator), CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist-Physician), CPC (Certified Professional Coder), or CPC-H (Certified Professional Coder-Hospital) as well as knowledge and training in more than two work types
• Three years of inpatient coding and/or CPT ambulatory surgery coding experience and the ability to mentor and train other coders is required
• Three years advanced medical and surgical coding experience in a large acute care facility is preferred

Qualifications

• Requires knowledge of medical terminology, anatomy and physiology necessary to code patient medical records utilizing established but specialized technical coding processes
• Requires knowledge of the fundamentals of DRG assignment and optimization
• Requires knowledge of state and federal regulatory guidelines for reimbursement in the prospective payment system in order to interface with physicians
• Requires the analytical skills to compile and process patient information abstracted from patient records
• Requires familiarity with computer data entry
• Requires accurate typing skills of at least 40 w.p.m
• An accuracy rate of 92% for inpatient and outpatient records is required for the Level I and II position. An accuracy rate of 95% for inpatient and outpatient records is required for the Coding Specialist position
• Demonstrates the interpersonal and communication skills (both verbal and written) necessary to interact with staff, physicians, and others
• Requires the physical ability, motor coordination and stamina to perform the essential functions of the position