Job Description
The Inpatient Coder (inpatient and ambulatory surgery) abstracts clinical information from a variety of medical records, charts and documents and assigns appropriate ICD-10 – CM/PCS and CPT codes to patient records according to established procedures. Works with coding databases and confirms DRG assignments. Familiar with standard concepts, practices, and procedures within a particular field. Relies on instructions and pre-established guidelines to perform the functions of the job. This position relies on guidelines and some experience and judgment to complete job and works under general supervision.
Responsibilities
- Coding/Abstracting
- Assists the Business Office and external agencies in clarification of coding regarding reimbursement issues. Handles all requests in a timely fashion.
- Quality/Performance
- Corresponds with other areas of the HIM department to ensure the necessary components are available for accurate coding and the highest quality of the patient’s medical record.
- Maintains an accuracy rate of not less than 93% based on internal and/or external review and a productivity standard per 8-hour day, engages in problem identification and solving, and assists in data gathering and chart auditing as necessary.
- Demonstrates competencies in the service to our patients/customers of all ages by obtaining information in terms of customer needs. Speaks in a positive, professional manner about co-workers, physicians, and the facility.
- Attends meetings as required and strives to improve the quality of meetings by taking an active role in meeting topics. Participates in educational programs, in-services, and training sessions in an effort to share his/her own expertise with others and further the quality of education and personal growth provided to new personnel, volunteers, and interning students.
- DRG Coding Confirm APC Assignment
- Determines the appropriate sequencing of diseases, diagnoses, and surgeries. The Coder accurately assigns appropriate codes to patient records using ICD-10-CM/PCS system and CPT guidelines.
- Other Duties as Assigned
- Performs other duties as assigned or requested.
Work from Home position!!
- Performs other duties as assigned or requested.
Qualifications
Experience Required:
RHIT/RHIA plus 5 years of acute care coding experience
OR
RHIT/RHIA with ICD-10 curriculum plus 3 years of acute care coding experience
OR
7 years acute care coding experience; CCS substitutes for 1 year of acute care coding experience.
Education:
High School or equivalent
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