Under the direct supervision of the Coding Manager, the Coder 4 is responsible for coordinating the ED/OP or the IP/SDS coding quality review program and physician documentation improvements in this area. This includes initiating physician and clinician education activities to support coding practices and training and education of new and existing coders on coding rules/changes. The hospital services that are coded in this position may include acute inpatient (including Obstetric and Newborn), Physical Rehabilitation, Behavioral Health, Same Day Surgery, Interventional Radiology, Emergency Department records and Outpatient Ancillary.
Major Position Responsibilities:
- Initiates Physician documentation improvement education/communication activities to include meetings, postings, newsletters, etc.
- Creates on-going education/training activities for new and experienced coders to address new coding practices and problematic areas identified in quality reviews.
- Reviews accounts monthly identified with Hospital-Acquired Conditions to confirm supporting documentation.
- Participates in RAC Steering Committee as support in conducting coding audits to evaluate compliance with coding guidelines, MS-DRG/APC (IP/SDS) or CPT/APC (ED/OP) assignment, and abstracting practices.
- Formalizes coding guidelines and procedures to reflect current practice and supports coder self-development in creation of guidelines.
- Coordinates coding section participation in addressing issues affecting coding performance (i.e. billing edits, Core Measures, system upgrades).
- Conducts audits with summarization of results and development of action plans.
- Facilitates coder training relating to the transition to ICD-10 and ICD-10-PCS.
- Responsible for on-going education to maintain current professional certification. Responsible for the review and comprehension of current information regarding coding and compliance issues.
- Codes records of discharged patients using the current ICD-9-CM, and/or ICD-10-CM, ICD-10-PCS and CPT/HCPCS coding system guidelines in accordance with regulatory compliance and quality monitoring criteria and actively participates in transition to ICD-10-CM and ICD-10-PCS.
- Adheres to the AHIMA Standards of Ethical Coding developed by the AHIMA Council on Coding and Classification.
- Queries the physicians as needed to obtain clarification of chart documentation to accurately assign codes to reflect the patient’s diagnoses and procedures performed and maintains supporting documentation obtained.
- Abstracts data from the medical record document according to data collection, reporting, and billing requirements in compliance with quality monitoring criteria.
- Verifies that patient abstracts have been completed for all the required patient hospital services monthly for data retrieval, hospital Case Mix reporting, and billing of the outstanding account receivables (delinquent data).
- Performs other related duties as requested by Management.
Safety and Infection Control Responsibilities
- Responsible to maintain a safe and clean work environment, including unit based specific safety and infection control requirements.
Qualifications: ESSENTIAL COMPETENCIES, KNOWLEDGE, & EXPERIENCE
- Five (5) to seven (7) years current acute care/hospital/outpatient coding experience, required.
- Internal transfer: will consider two years Coder 3 experience at Tri-City Medical Center in lieu of 5 to 7 years current acute care/hospital/outpatient coding experience.
- Experience in Emergency and Outpatient Ancillary coding required (ED/OP only).
- Extensive background in acute care and outpatient surgery coding required (IP/SDS only).
- Experience in coding within the state of California, preferred.
- Knowledgeable in Clinical disease processes and their relationship to coding guidelines, required.
- Excellent verbal and written communication and organization skills for interactions with Coders and Physicians.
- Experience in conducting audits with summarization of results and development of action plans, preferred.
- Detail oriented with strong analytical skills, required.
- Ability to demonstrate flexibility in response to unexpected changes in work volume and work schedule, required.
- Excellent human relations skills including listening, conflict resolution, and team building, required.
- Previous Supervisor /Lead experience preferred
- Technical experience to include use of the encoder and grouping products and coding reference materials, required.
- Advanced knowledge of Microsoft Office products (Word, Excel, Outlook), required.
- Successful completion of skills assessment with a score of at least 80% that evaluates application of candidate’s knowledge, required.
- High School diploma or GED, required.
Requires 1 of the following:
- Current Registered Health Information Administrator (RHIA)
- Current Registered Health Information Technician (RHIT)
- Current Certified Coding Specialist (CCS)
- Current Certified Inpatient Coder (CIC)
Each new hire candidate who is offered employment must pass a physical evaluation, urine drug screen and pre-employment background checks before starting work.