Medical Coder II - HIM Hospital IP

Job Description

Description

Become part of an inclusive organization with over 40,000 diverse employees, whose mission is to improve the health and well-being of the unique communities we serve.

Summary:

Performs technical and administrative work reviewing, abstracting and assigning accepted medical codes for inpatient (Hospital Billing -Health Information Management) diagnoses, procedures and services. Duties are performed in compliance with third party, state and federal regulations according to standardized procedures.

Responsibilities:

1. Assigns International Classification of Diseases 10-CM diagnostic and ICD-10-PCS procedural codes accurately and productively and other applicable codes such as MS-DRG on inpatient cases for all entities within the Health Care system including Academic Medical Center cases.
2. Groups codes and completed product into payment group.
3. Assigns codes that affect Severity of Illness and Risk of Mortality and Hierarchal Condition Categories (HCCs).
4. Participates in DRG Reconciliation with Clinical Documentation Specialist (CDS).
5. Queries providers when documentation is conflicting, needs clarification and specificity.
6. Analyzes information for optimal and proper reimbursement.
7. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures.
8. Provides information to physicians and other health care staff regarding current coding practices and changes in 3rd party, state and federal regulations and guidelines.
9. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures, discharge disposition and other services provided.
10. Obtains missing information and/or to clarifies existing information.
11. Accepts feedback from PWC Smart reviews and makes edits as needed to avoid future errors.
12. Reviews and processes PWC SMART edits.
13. Researches appropriate databases for validation of information.
14. Utilizes a variety of software (e.g. Epic, Optum CAC, MS Office, etc.) to compile and validate medical information.

Job Requirements:

• High School diploma or GED
• Successful completion of the UNC HCS IP Coder Proficiency Test (including AMC).
• Must have AHIMA (American Health Information Management Association) certification and credential OR AAPC (American Academy of Professional Coders) certification and credential
• Four (4) years of experience in hospital inpatient coding.
• Strong knowledge of ICD-10-CM/PCS coding with excellent analytical and data mining skills. 
• Ability to effectively manage projects, plan and implement programs, and evaluate outcomes, and effectively work with direct various levels of staff (including on-site and remote) and mentoring colleagues. 
• Effective organizational skills, time management, and management of multiple priorities. 
• Ability to interpret complex medical conditions and work with complex coding applications. 
• Ability to interpret federal and state regulations as they relate to coding and compliance.
• Excellent balance of being highly productive and yet produce high quality work. 
• Strong communication skills, both written and verbal and have extensive attention to detail.