Health Information Coder (Per Diem)

About the Role

Performs ICD and CPT coding of inpatient and outpatient medical records. Analyzes, sequences, and validates assigned codes based on medical record documentation using automated encoders, coding books, and compliance resources. Demonstrates a complete understanding of coding rules, anatomy, physiology, and medical terminology to appropriately code patient information.

Reviews medical record documentation to determine and assign diagnoses, procedures, level codes, and modifiers, ensuring appropriate coding for case mix. Selects the appropriate reimbursement grouper based on financial class for each account and ensures coding compliance with regulatory and reimbursement requirements.

Abstracts and enters diagnosis, procedures, and level codes with demographic, clinical, and related patient information into Medical Record Abstracting and/or Billing/Accounts Receivable systems. Assesses documentation adequacy, queries physicians and healthcare providers for clarification, and retrieves medical records for coding in accordance with departmental procedures.

Responsibilities

• Maintains a 95% ongoing accuracy rate based on department performance monitors and third-party validation audits.
• Consistently achieves weekly coding output within minimal productivity standards.
• Self-manages and prioritizes workflow to ensure timely submission of claims and optimal productivity.
• Maintains accurate productivity logs and provides this information to the Coding Manager in a timely fashion.
• Assists in the orientation and development of new coding personnel.
• Pursues ongoing education to maintain certification and stays current with developments in health information management.
• Monitors medical record documentation, coding systems, and department workflow to identify and address errors, compliance issues, and inefficiencies.
• Communicates with the Coding Manager to implement solutions that improve productivity and efficiency.
• Performs all duties in accordance with the Hospital’s Customer Service standards.
• Provides service excellence to patients, family members, visitors, volunteers, and co-workers, reflecting the Hospital’s commitment to CARES: compassion, accountability, respect, excellence, and service.
• Performs other work-related duties as assigned or requested.

Requirements

• Ability to read, write, and communicate in English.
• Current CCS (AHIMA Certified Coding Specialist) certification.
• 6 months of PC Windows experience.

Qualifications

Grade S14/Job Code 9064:

• 2 years of CCH outpatient coding experience as an Outpatient Health Information Coding and Reimbursement Specialist.
• 6 months of coding experience in one of the following outpatient specialties: Pain Management, Surgical Day Care, Oncology, Radiation, or Observation.

Grade S15/Job Code 9164:

• 6 months of inpatient coding experience.
• Successful passage of the Medical Record Department Inpatient Coding exam with a grade of 80% or better.

Schedule

• Per Diem Hours, Rotating Days.
• Shifts: 8:00 AM – 4:00 PM.
• Occasional weekends and holidays.
• Remote work.

Pay

Hourly pay range: $27.35 – $44.93.