Coding Specialist HIM Senior

Coding Specialist Him Senior

Fully remote position. Inpatient coder. The senior coding specialist is responsible for accurately assigning and sequencing ICD diagnostic and procedural codes and/or CPT procedural codes to inpatient and outpatient records.

Essential duties and responsibilities include:

1. Coding diagnostic and procedural information from the record using ICD and CPT/HCPCS classification systems
2. Utilizing a computerized encoding system to facilitate accurate coding
3. Sequencing diagnoses and procedures by following the ICD, Uniform Hospital Data Set, Medicare, Medicaid, and other fiscal Intermediary guidelines
4. Working cooperatively with the medical staff and other healthcare professionals in obtaining documentation to complete medical records and ensure quality coding
5. Selecting the DRG for each inpatient discharge and APC for each outpatient visit, ensuring coding compliance based on approved coding guidelines and conventions
6. Abstracting medical data from the record to complete a discharge abstract on each inpatient, ambulatory surgery, emergency room, outpatient, and ancillary visit, completing and verifying diagnostic and demographic information
7. Entering patient information into computerized inpatient and outpatient medical record databases
8. Ensuring the accuracy and integrity of medical record abstract data prior to billing interface and claims submission
9. Routinely coding inpatient records to meet productivity and quality standards for inpatient coding
10. Coding outpatient, emergency department, and outpatient diagnostic records as determined by Coding Operations Manager
11. Consistently maintaining established productivity requirements and maintaining a 96% or greater accuracy rate
12. Communicating and advising the Patient Accounts on coding and DRG/APC assignment and submission
13. Assisting the Coding Compliance Specialist and/or Coding Operations Manager as needed
14. Filling in for the Coding Compliance Specialist and/or Coding Operations Manager as needed
15. Completing other duties as assigned

Summary of other job duties and expectations include:

1. Adhering to the Service Excellence Standards and Expectations at Chesapeake Regional Medical Center
2. Exhibiting excellent customer relations to patients, visitors, physicians, and co-workers
3. Exhibiting courteous communication skills and an ability to work with others, exercising good judgment in performance of job duties
4. Demonstrating courtesy, compassion, and respect to others in adherence of the hospital's philosophy and policy for promoting positive work and customer environments
5. Working as a team to continuously improve work quality
6. Demonstrating a commitment to flexible work schedules when it is necessary to ensure patient care
7. Presenting self in a positive manner as reflected by personal attire, etiquette, and behavior
8. Attending required hospital-wide orientations, meetings, and in-services

Qualifications:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Education and experience:

Minimum required education: completion of a Health Information Management program with AHIMA approval status or coding program with AAPC

Experience: 4+ years recent experience coding in an acute hospital setting required; coding ability will need to be demonstrated via a skills assessment

Certificates, licenses, registrations:

Certification in RHIA or RHIT and CCS or CIC is required. In addition, also prefer outpatient coding certifications through AHIMA and AAPC.

Equal opportunity employer. This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor.