Inpatient Medical Coder

About the role

Responsible for assignment of accurate ICD codes for diagnoses and procedures. Medical Severity - Diagnostic Related Group (MS-DRG) is automatically assigned by the grouper software) for inpatient stays. Inpatient coders may also be responsible for the assignment of accurate ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers, and quantities from medical record documentation (paper or electronic) for inpatient professional services (a.k.a., rounds or IBWA encounters).

Responsibilities

• Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities.
• Applies ICD codes for diagnoses and procedures (Diagnostic Related Group is automatically assigned by the grouper software) for inpatient stays.
• Identifies and extracts information from medical records (paper or electronic) for special studies and audits, internal and external.
• Interacts with MTF staff to ensure documentation is clear and supports coding assignments. Educates MTF staff through individual or group in-services and training sessions.
• Maintains a delinquency report of missing documentation for inpatient records in order to facilitate completion of work within the required thresholds.
• Ensures all required component parts of the inpatient medical record that pertain to coding are present, accurate and compiled with DoD and accreditation requirements.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance, including seeking clarification from the contractor supervisor or DHN Pacific Rim.
• Reviews and resolves coding edit failures in MHS GENESIS®.

Requirements

• Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (inpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
• The following are recognized certifications: Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), and Certified Coder Specialist (CCS) are acceptable for inpatient coders.
• Applicant must have the ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.

Qualifications

• Minimum of five (5) years of medical coding and/or auditing experience in two (2) or more medical, surgical, and ancillary specialties within the past 10 years; OR a minimum of three (3) years of medical coding or auditing experience if that experience was in an MTF. A minimum of one (1) year of performance in the specialty is required to be documented to be considered qualifying.

Skills

• Advanced knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT), as used in institutional and professional services medical coding.
• Advanced knowledge of reimbursement systems, including Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale (RBRVS).
• Advanced knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to: Laboratory, Dental, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management concepts related to medical coding.
• Practical knowledge and understanding of Government rules and regulations regarding medical coding, reimbursement guidelines, and healthcare fraud; commercial reimbursement guidelines and policies; coding audit principles and concepts, and potential areas of risk for fraud and abuse. Includes, but not limited to: The Federal Register, Center for Medicare, and Medicaid Services (CMS) Local Coverage Determinations and National Coverage Determinations (LCD and NCD), National Correct Coding Initiative (NCCI) guidance, manual, and edits, Internet-Only Manuals (IOMs), and HHS-OIG publications and reports.
• Practical knowledge of clinical documentation improvement and continuous process improvement processes.
• Practical knowledge of EHR systems and workflows pertaining to medical coding.

Benefits

• Paid time off
• Sick time
• Paid holidays
• $20,000 company paid life insurance policy
• Medical insurance (employee only coverage)
• Dental, vision and voluntary life insurance (optional)
• Retailment plan
• Critical illness and accident policies (provided through section 125 tax credits for qualifying employees)