Senior Coding Specialist

About the role

The Senior Coding Specialist independently reviews, accurately assigns, and abstracts diagnostic and procedural codes to encounters using designated coding classifications. They also perform validation of Medicare Severity Diagnosis Related Groups (MS-DRG) reviews, maintain required performance levels in coding accuracy and productivity, and interact with physicians to obtain pertinent medical input.

Responsibilities

• Performs validation of Medicare Severity Diagnosis Related Groups (MS-DRG) reviews.
• Maintains concurrent entry in the case review information system for all cases selected for review.
• Records clear and concise rationales for review decisions citing appropriate references as applicable.
• Demonstrates clear written and oral communication skills utilizing proper grammar, punctuation, spelling, and syntax.
• Interacts with educators regarding potential hospital coding patterns.
• Composes letters to providers explaining review details and recommends changes to the codes and MS-DRGs submitted.
• Protects the confidentiality of patient information through compliance with the Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health Act (HITECH).
• Attends annual security awareness, rules of conduct, and conflict of interest training.
• Performs other duties as assigned.

Requirements

• Advanced knowledge of International Classification of Diseases (ICD)-10 codes and Diagnosis Related Group (DRG) classification system.
• Experience using industry tools, such as Encoder, Grouper, and American Hospital Association (AHA) Coding Clinic.
• Preference for personnel with current unrestricted credentials of Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS).
• Licenses must be recognized in the jurisdiction(s) relevant to the work assigned.
• Must be able to apply all relevant ICD-10 diagnosis and procedure coding guidelines for appropriate MS-DRG assignment.

Essential Knowledge

• Advanced knowledge of International Classification of Diseases (ICD)-10 codes and Diagnosis Related Group (DRG) classification system.
• Experience using industry tools, such as Encoder, Grouper, and American Hospital Association (AHA) Coding Clinic.

Essential Education

• Preference for personnel with current unrestricted credentials of Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS).

Essential Skills

• Senior-level inpatient hospital coding experience.
• Writes in plain language, summarizing medical facts and coding principles that support coding decisions, including appropriate references from authoritative sources.
• Able to coordinate work and communicate efficiently with physician reviewers responsible for making clinical decisions.

Organizational "Fit" Considerations

• This position may require extended work hours during the week, weekends, holidays, and on-demand.

Additional Considerations

• Work Environment/Physical Demands: The work environment and physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This is an office/remote position. While performing the duties of this job, the employee regularly works in a climate-controlled environment. Candidates must be able to sit, read, work on a computer, and watch a computer screen for extended periods of time. Occasionally required to stand, walk, use hands and fingers, kneel or crouch.

Salary

$70,000 - $85,000 annually