HIM Coder III

About the Role

Provides timely and accurate administrative and clinical data through the accurate assignment of current ICD-10-CM/PCS, CPT, or HCPCS codes while complying with the regulations and requirements of the Federal Government, State licensing agencies, and the Hospital’s policies and procedures. Supports management planning processes and ensures appropriate reimbursement for services.

Responsibilities

• Assigns the correct ICD-10-CM, ICD-10-PCS, CPT, or HCPCS codes to each diagnosis and operative procedure substantiated by documentation in the medical record using current code sets.
• Accurately codes inpatient or outpatient record types, including a minimum of four outpatient areas independently: emergency, same-day surgery, observation, pain clinic, wound clinic, diagnostics, and recurring accounts.
• Follows departmental and official coding guidelines to ensure consistent and accurate coding of diagnostic and procedural data.
• Utilizes 3M 360, CAC (Computer Assisted Coding), Epic, and other necessary applications for proper coding and accuracy.
• Ensures medical staff documentation contains sufficient information for accurate coding and appropriate reimbursement; requests clarification from providers when information is incomplete.
• Assists physicians, their office staff, quality management, and other hospital personnel with coding, DRG, and APC questions.
• Determines the sequence of diagnoses according to UHDDS (Uniform Hospital Discharge Data Set) standards.
• Inputs abstract data and codes into computer systems to gather administrative and clinical data for distribution to regulatory agencies, third-party payers, administrative staff, and physicians.
• Ensures compliance with institutional policies and procedures for medical record maintenance.
• Maintains current knowledge of coding principles and guidelines as coding conventions are updated.
• Maintains a 95% coding accuracy rate and achieves 95% of standard weekly productivity.
• Reviews charts returned by payers for challenges.
• Adheres to organizational and department-specific safety, confidentiality, values, policies, and standards.
• Performs related duties as assigned.

Requirements

• Completion of a 2-year college or technical school curriculum in Health Information Management, or an equivalent combination of relevant education and experience. Preferred: completion of a 4-year college curriculum in Health Information Management.
• Five years of acute care hospital coding experience.
• One of the following certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC), or Certified Outpatient Coder (COC).

Skills

• Knowledge of current ICD-10-CM, ICD-10-PCS codes, APC reimbursement models, UHDDS sequencing, and DRG payment methodologies (including MS-DRGs and APR-DRGs).
• Knowledge of medical terminology.
• Skill in coding medical information and maintaining databases to ensure accuracy.
• Skill in organizing tasks to ensure timely and accurate coding.
• Strong oral and written communication skills.
• Ability to read, analyze, and interpret professional journals, governmental regulations, and coding guidelines.
• Ability to follow written and verbal instructions.
• Ability to maintain effective working relationships and communication with medical staff, nursing, administration, and other hospital departments.
• Ability to perform multiple tasks and meet strict deadlines.