About this role
Role Overview
- Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply with standard provider coding regulations
- Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses and procedures are recorded
- Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form using procedure codes as required
- Using the Encoder software program, determines the codes for all diagnoses and procedures
- Determines their sequencing to legally maximize reimbursement
- Assigns the appropriate 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 as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding
- Reviews coding guidelines on an annual basis and makes recommendations for change to improve coding and data management
- Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies, etc. documented within patient records to ensure that appropriate diagnosis and procedure codes are selected and incorporated into hospital and professional coding guidelines
- Updates and corrects historical file data by completing and submitting claim action reports per the PHC4 quarterly report
Requirements
- Certification Requirement for Level II and above
- One relevant certification from AHIMA or AAPC is required 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 are required to obtain a CCS, RHIT, or RHIA within 12 months of hire
- All certifications are acceptable from AAPC (American Academy of Professional Coders) except: Scribe, Documentation, Instructor, and International Credentials
- Relevant coding certification
- Default Issuing Body
- High School Diploma or Equivalent (GED)
- (Required)
- Graduate from Specialty Training Program
- (Preferred)
- Minimum of 1 year-Related work experience (Required)
Benefits
- healthcare benefits for full time and part time positions from day one
- vision
- dental
- benefits for domestic partners