Coder lll -Inpatient Coder

Insight Hospital and Medical Center Chicago

At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides patient care second to none!

Position Purpose

Provides high level technical competency and subject matter expertise analyzing physician/provider documentation contained in assigned Complex Outpatient (CO) and/or Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Provides appropriate Medical Severity Diagnostic Related Groups (MS-DRG), Present on Admission (POA), Severity of Illness (SOI) & Risk of Mortality (ROM) assignments for Inpatient records and accurate APC assignments and all required modifiers for Complex Outpatient records. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes, MS-DRG, POA, SOI & ROM assignments and assignment of APC's and all required modifiers.

Assigns appropriate code(s) by utilizing coding guidelines established by:

• The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting
• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
• American Medical Association (AMA) CPT Assistant for CPT codes
• American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Revenue Excellence/RHM Organization coding policies

Essential Functions

• Knows, understands, incorporates, and demonstrates the Insight Hospital Mission, Vision, and Values in behaviors, practices, and decisions.
• Adheres to Insight Health confidentiality requirements as they relate to the release of any individual or aggregate patient information.
• Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.
• Codes Complex Outpatient or Inpatient utilizing encoder software and online tools and references, in the assignment of ICD, CPT, HCPCS codes, MS-DRG, POA, SOI & ROM assignments, APC assignment and all required modifiers.
• Consults reference materials to facilitate code assignment.
• Understands appropriate link of diagnosis to procedure.
• Appends modifier(s) to procedure code or service when applicable.
• Collaborates with HIM and Patient Financial Services in resolving billing and utilization issues affecting reimbursement.
• Interprets bundling and unbundling guidelines (NCCI).
• Interprets LCDs/NCDs and payer policies.
• Tracks issues (i.e., missing documentation, charges or Inpatient queries that require follow-up to facilitate coding in a timely fashion).
• Investigates claims denials and/or appeals as directed.
• Consistently meets or exceeds coding quality and productivity standards.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Identifies concerns and responsible for providing resolution of moderate to complex problems. Notifies appropriate leadership for resolution when appropriate.
• Performs other duties as assigned by Leadership.
• Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior

Minimum Qualifications

• Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate's degree in Health Information Management or a related field or an equivalent combination of years of education and experience is required. Bachelor's degree in Health Information Management (HIM) or related healthcare field is preferred.
• Certified Coding Specialist (CCS), Certified Procedural Coder (CPC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA).
• Two (2) years of current Complex Outpatient or Inpatient coding experience is required. Three (3) to five (5) years of current Complex Outpatient or Inpatient coding experienced preferred. Current experience doing remote coding is a plus.
• Extensive comprehensive working knowledge of medical terminology, Anatomy and Physiology, diagnostic and procedural coding and MS-DRG or APC grouping. Current experience doing remote coding is a plus.
• Current experience utilizing encoding/grouping software or CAC is preferred. Ability to utilize both manual and automated versions of the ICD, CPT, and HCPCS coding classification systems is preferred.
• Ability to use a standard desktop and windows-based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.
• Strong written and oral communication skills, that may be used either on-site or in virtual working environments. Ability to communicate effectively with individuals and groups representing diverse perspectives.
• Ability to work with minimal supervision and exercise independent judgment.
• Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload.
• Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills.
• Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions.
• Ability to change and be flexible with work priorities. Strong problem solving- abilities.
• Must be comfortable functioning in a virtual, collaborative, shared leadership environment.
• Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Insight Hospital, Chicago.

Physical and Mental Requirements and Working Condition

• Must be able to set and organize own work priorities and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments that may be stressful with individuals having diverse personalities and work styles.
• Must possess the ability to comply with Insight Hospital policies and procedures.
• Must be able to spend majority of work time utilizing a computer, monitor, and keyboard.
• Must be able to perform some lifting and/or pushing/pulling up to 20 pounds if applicable.
• Must be able to work with interruptions and perform detailed tasks.
• If applicable, involves a wide array of physical activities, primarily walking, standing, balancing, sitting, squatting, and reading. Must be able to sit for long periods of time.
• Must be able to travel to Insight Hospital (10%) as applicable.
• If applicable, telecommuting (working remotely), must be able to comply with Insight Hospital Working Remote Policy.

Benefits

• Paid Sick Time - effective 90 days after employment
• Paid Vacation Time - effective 90 days after employment
• Health, vision & dental benefits - eligible at 30 days, following the 1st of the following month
• Short and long-term disability and basic life insurance - after 30 days of employment