Position Summary
The role of the Coding Specialist – Certified reports to the Coding Manager. This position is responsible for the application of the appropriate diagnostic and procedural codes to individual patient medical records for data retrieval, analysis and claims processing.
Essential Position Responsibilities
- Abstract pertinent information from patient records into the appropriate computer system for statistical and billing purpose; assigns the correct ICD-CM, ICD-PCS, discharge disposition, MS-DRG group assignments and other data as applicable
- Coordinate with the clinical documentation and quality teams to ensure validation of Medicare Severity Diagnosis Related Group (MSDRG), patient safety indicators, and hospital acquired conditions are supported by physician documentation to support appropriate coding
- Works with Clinical Documentation Specialists (CDS) and physicians to identify and address documentation improvement needs that support accurate code, Risk of Mortality (ROM), Severity of Illness (SOI), and DRG assignment
- Query physicians if there are discrepancies in the code assignment or documentation in the electronic medical record is inadequate
- Remain knowledgeable of current coding guidelines, reimbursement, and reporting requirements
- Ensure coding accuracy rate is met as established by department goals and objectives
Qualifications
- Education: High School Diploma or GED
- Licensure and Certifications: RHIA, RHIT, CCS, CIC, CPC, CCA, required.
- Experience: Minimum of 6 months of coding experience, required. Minimum 2 years inpatient coding experience, preferred. Experience with Clinical Documentation Improvement programs and clinical validation, preferred. Working knowledge of quality metrics and risk adjustment coding impacts, preferred.
Work Environment: This position will spend 90+% of the time sitting while performing work in a standard office environment.