Sr Inpatient Coding Specialist

Job Description

Reviews, analyzes, and interprets clinical documentation applying applicable codes in accordance with prescribed rules, coding policy, payer specifications, and official guidelines.

Evaluates and optimizes various diagnostic options in accordance with standard rules, official coding guidelines, regulatory agencies, and approved policies.

Verifies assigned codes and ensures diagnostic and procedure codes are supported by the physician’s clinical documentation.

Communicates effectively with physicians and allied health personnel to ensure comprehensive, accurate, and timely clinical documentation.

Discusses optimization and documentation issues with physicians and clinical personnel, querying for clarification of discrepancies, additional diagnoses, complications, or co-morbid conditions.

Applies necessary codes, understanding their impact on mortality rates, clinical quality, reimbursement, and key quality indicators.

Utilizes a thorough understanding of coding guidelines, guidance, medical necessity, and coverage determinations.

Uses critical thinking and sound judgment in decision-making, balancing reimbursement considerations with regulatory compliance.

Knowledge, Skills, and Abilities

• Thorough knowledge of Medicare reimbursement methodology, documentation guidelines, data abstraction, and encoder functionality.
• Excellent interpersonal skills including excellent verbal and written communication skills; proficient in and demonstrate excellent physician relations.
• Computer skills, including Microsoft Office and Encoder software.
• Self-motivated and able to work independently in a remote setting.
• Critical thinking and problem-solving skills.
• Comprehensive knowledge of coding functions, rules, and guidelines as it relates to DRG assignment.
• Strong ability to organize/triage work and manage multiple priorities simultaneously with little supervision.
• Possesses knowledge about risk adjustment and publicly reported hospital data.
• Possesses knowledge about patient safety indicators, SOI/ROM, and the importance of hospital publicly reported data, value-based purchasing, and how coding impacts these measures.

Education

• Bachelor's [Preferred]
• High School Grad or Equiv [Required]
• Field Of Study and two years of coding education (medical coding certificate program, diploma or 2-year HIM program), including medical terminology, anatomy & physiology, and pathophysiology coursework.

Work Experience

• 5+ of inpatient hospital coding experience, including cases requiring specialized coding skills, such as cardiovascular surgery, neurosurgery, trauma surgery, neonatology, pediatrics, plastic and reconstruction surgery, bariatric surgery, cardiology, and other services and procedures provided in a tertiary care facility. [Required]
• Comprehensive experience with cases requiring more complex coding skills, such as advanced cardiovascular, cardiothoracic, neurological, and orthopedic surgical procedures, extended or prolonged length of stays (> 100 days), BMT and other solid organ transplantations, ECMO, cutting-edge surgical advancements that are considered new and innovative, procedures that may be considered experimental or research-based, and other complicated treatments or procedures provided in a quaternary care facility. [Preferred]

Additional Information

N/A

Licenses And Certifications

• Registered Health Information Administrator (RHIA) [Required]
• OR Registered Health Information Technician (RHIT) [Required]
• OR Certified Coding Specialist (CCS) [Required]
• OR Infection Control Certification (CIC) [Required]
• OR Certified Radiologic Technologists (RT-CERT) [Preferred]
• OR Registered Nurse (RN) [Preferred]

Physical Requirements

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Pay Range

$23.91 - $44.46