Inpatient Coding Specialist / Abstraction (Full Time or Per Diem) Hybrid Work

Qualifications

• Associate’s degree in health information management or equivalent from two-year college.
• Minimum 3 years coding inpatient records in acute or acute/long term care setting.
• Experience with coding outpatient/clinic records desirable.
• Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician-based (CCS-P), or Certified Professional Coder-Payer (CPC-P), or able to achieve certification within 2 years of hire.
• Ability to read, analyze, interpret ICD-9, ICD-10, CPT, HCPCS and Modifier books.
• Ability to document and follow-up on Discharged Not Final Billed (DNFB) reports and to effectively present information and respond to questions from Administration, Physicians, and committee members.
• Can effectively describe when and how to use modifiers on CPT codes to physicians and other healthcare providers.
• Understands denials and how to solve them.
• Must be proficient in Anatomy and Physiology, Medical Terminology, and 3M applications.
• Past experience using 3M HDM report writer a plus.
• Must be familiar with a hybrid medical record and working with an electronic medical record.
• Must have experience with proper DRG assignment.
• Registered Health Information Technician (RHIT) certification is a plus.

Responsibilities

• Responsible for the coding and facility charge process for inpatient accounts, may assist from time to time with outpatient coding.
• Abstracts clinical information from medical records and assigns appropriate ICD 10 diagnoses and procedure codes as appropriate and CPT modifiers according to coding guidelines and established procedures.
• Edits and resolves outstanding edits and denials for assigned case load weekly.
• Communicates to clinicians to resolve issues.
• Follows up with providers for any records which cannot be completed for lack of documentation or clarification.
• Distributes coding queries as appropriate.
• Provides information/training to clinical staff and providers on changes in coding practices such as ICD-10, CPT and modifiers, appropriate documentation practices, and DRG assignments as needed.
• Serves as a resource for all hospital staff with questions related to Inpatient ICD 9/10 coding, CPT modifier and DRG assignments.
• Participates in training, updates and knowledge-based review on utilizing the Electronic Medical Record to maximize efficient use for coding.
• Maintains knowledge of Inpatient coding practices and procedures.
• Maintains knowledge of Federal, State, and JC standards of documentation regulations and guidelines.
• Maintains and keeps coding credentials current.