Coder / Abstractor III

Job Description :

This salary range may be inclusive of several career levels at Valley MedicalCenter and will be narrowed during the interview process based on several factors, including (but not limited to) the candidate's experience, qualifications, location, and internal equity.

JOB DESCRIPTION

The position description is a guide to the critical duties and essential functions of the job, not an all-inclusive list of responsibilities, qualifications, physical demands, and work environment conditions. Position descriptions are reviewed and revised to meet the changing needs of the organization.

TITLE : Coder / Abstractor III

JOB OVERVIEW : Responsible for hospital inpatient coding and abstracting based on documentation and coding guidelines within established productivity standards for all accounts assigned. Resolves coding related edits and denials and provides ongoing feedback and education to physicians and clinicians. Responsible for following up on all accounts unable to code due to missing / incomplete documentation or charges.

DEPARTMENT : Health Information Management

HOURS OFWORK : As assigned

RESPONSIBLE TO : Manager, Health Information Management

PREREQUISITES :

Associate or bachelor's degree in HIM, required.

RHIA, RHIT, or CCS required.

3 or more years exclusively in inpatient hospital coding experience, required.

Demonstrated advanced ability to use and understand DRG, ICD-10-CM, and ICD-10-PCS coding methodologies.

Advanced knowledge of anatomy, physiology, pharmacology, disease processes and medical terminology

Ability to communicate in writing and verbally in the English language in an effective manner. Effective communication includes ability to spell accurately and write legibly.

QUALIFICATIONS :

Ability to research authoritative citations related to coding, compliance, and additional reporting needs.

Ability to carry out assignments independently, follow procedures, and exercise good judgment.

Excellent customer service skills, including telephone interactions.

Proficient data entry skills.

Proven ability to interact with physicians and support staff.

Attention to detail and excellent organizational skills are essential.

Knowledge of Medicare, Medicaid, and third-party coding and billing requirements.

Successful completion or pre-hire coding test.

UNIQUE PHYSICAL / MENTAL DEMANDS, ENVIRONMENT AND WORKING CONDITIONS :

Must be able to prioritize and multi-task. Must possess ability to work independently, with a minimum of direction, and take initiative in problem solving. Must be able to interact professionally and effectively with a wide variety of people, including operations staff, providers, the public, and departments in VMC. Must be able to function effectively in an environment with frequent interruptions and multiple tasks. Requires manual and finger dexterity and vision corrected to normal range. Requires ability to travel several miles to various sites on any given day.

PERFORMANCE RESPONSIBILITIES :

Generic Job Functions : See Generic Job Description for Administrative Partner.

Essential Responsibilities and Competencies :

Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG).

Responsible for final coding and DRG accuracy on all inpatient accounts.

Maintains confidentiality of protected health information.

Reviews coding-based edits, corrects errors, and educates clinic and medical staff on appropriate use of ICD-10-CM and ICD-10-PCS codes.

Demonstrate advanced competency with ICD-10-CM and ICD-10-PCS code assignment for diagnoses and procedures for hospital requirements.

Collaborates with Clinical Documentation Specialists, HIM deficiency team, and members of the medical staff to ensure completeness of documentation in the charts so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.

Codes all records based on documentation, being careful to follow strict coding guidelines, payer regulations, and ethics.

Ensure compliance with all Federal and State guidelines regarding correct coding initiatives.

Meets productivity coding standards as outlined in the productivity policy.

Participates in coding meetings to enhance knowledge and coding compliance skills.

Communicates effectively with Revenue Cycle team and hospital departments in relationship to coding or charging concerns and the submission of claims.

Reviews coding-based payment denials, identifies patterns, corrects errors, and educates clinic and revenue cycle staff on appropriate coding procedures when services are denied due to inappropriate diagnosis or procedure coding.

Provides immediate telephone support to clinic, medical, and revenue cycle staff who have coding questions.

Assists with new provider orientation on VMC's coding, audit process and documentation standards.

Apprises management of concerns as appropriate, including backlogs and time available for additional tasks.

As necessary, negotiates a work improvement plan with management to raise work quality and quantity to standards.

Maintains appropriate CEU's annually as required for certification.

Adheres to policies and procedures as required by VMC.

Performs all job functions in a manner consistent with Valley's expectations as defined in Valley Values.

Completes additional projects and duties as assigned.

Created : 1 / 21

Revised : 8 / 22

Grade : OPEIU - O

FLSA : NE

CC : 8490

Job Qualifications : PREREQUISITES :

Associate or bachelor's degree in HIM, required.

RHIA, RHIT, or CCS required.

3 or more years exclusively in inpatient hospital coding experience, required.

Demonstrated advanced ability to use and understand DRG, ICD-10-CM, and ICD-10-PCS coding methodologies.

Advanced knowledge of anatomy, physiology, pharmacology, disease processes and medical terminology

Ability to communicate in writing and verbally in the English language in an effective manner. Effective communication includes ability to spell accurately and write legibly.

QUALIFICATIONS :

Ability to research authoritative citations related to coding, compliance, and additional reporting needs.

Ability to carry out assignments independently, follow procedures, and exercise good judgment.

Excellent customer service skills, including telephone interactions.

Proficient data entry skills.

Proven ability to interact with physicians and support staff.

Attention to detail and excellent organizational skills are essential.

Knowledge of Medicare, Medicaid, and third-party coding and billing requirements.

Successful completion or pre-hire coding test.