Medical Coder (DRG coding experienced)

About the Role

Health information coding transforms verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders translate diagnostic and procedural phrases used by healthcare providers into coded form for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder ensures complete and accurate documentation, code assignment, and reporting of diagnoses and procedures.

Responsibilities

• Reviews the content of medical records for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses, and procedures performed, ensuring compliance with standard provider coding regulations.
• Conducts detailed reviews of documents such as laboratory findings, radiology reports, scan reports, discharge summaries, history and physical notes, consultations, orders, progress notes, and other ancillary service treatment records to ensure all pertinent diagnoses and procedures are recorded.
• Translates diagnostic and procedural phrases into coded form using procedure codes as required.
• Uses Encoder software to determine codes for all diagnoses and procedures and sequences them to legally maximize reimbursement.
• Assigns the appropriate Diagnosis-Related Group (DRG).
• Assigns codes based on hospital and professional coding guidelines, Coding Clinic directives, federal regulations, CCI coding initiatives, CPT Assistant, or other standard coding guidelines.
• Queries physicians to clarify documentation within patient records to facilitate complete and accurate coding.
• Applies internal policy and procedure guidelines regarding how to phrase physician queries.
• Assists the Coding Quality and Professional Manager with training new coding staff on hospital and professional coding guidelines, encoder software, and other systems needed for the coding process.
• Reviews coding guidelines annually and makes recommendations for changes to improve coding and data management.
• Communicates new diagnoses, procedures, or technologies documented in patient records to the Coding Quality and Professional Manager to ensure appropriate codes are selected and incorporated into guidelines.
• Updates and corrects historical file data by completing and submitting claim action reports per the PHC4 quarterly report.
• Works with other areas within the revenue cycle and external departments to ensure coordinated activities for all revenue cycle needs.

Requirements

• High School Diploma or Equivalent (GED) (Required).
• Minimum of 3 years of relevant experience (Required).
• One relevant certification from AHIMA or AAPC upon hire. Acceptable certifications include:
  • AHIMA (American Health Information Management Association):
    • Certified Coding Specialist (CCS)
    • Certified Coding Specialist – Physician-based (CCS-P)
    • Registered Health Information Technician (RHIT)
    • Registered Health Information Administrator (RHIA)
    • Certified Coding Associate (CCA) – Candidates with only a CCA must obtain a CCS, RHIT, or RHIA within 12 months of hire.
  • AAPC (American Academy of Professional Coders) – All certifications except Scribe, Documentation, Instructor, and International Credentials:
    • Certified Professional Coder (CPC)
    • Certified Outpatient Coder (COC)
    • Certified Inpatient Coder (CIC)
    • Certified Professional Biller (CPB)
    • Revenue Cycle Management Specialist (RCMS)
    • Certified Value-Based Administrator (CVBA)
    • Certified Physician Practice Manager (CPPM)
    • Certified Professional Compliance Officer (CPCO)

Benefits

• Healthcare benefits for full-time and part-time positions from day one, including vision, dental, and domestic partner coverage.
• Atmosphere of collaboration, cooperation, and collegiality from senior management down.

Geisinger is proud to be an affirmative action, equal opportunity employer. All qualified applicants will receive consideration for employment regardless of race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran.