CODER III - MEDICAL CODING

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Date: Feb 7, 2018

Location: Newport Beach, CA, US

Company: Hoag Memorial Hospital Presbyterian

Job Description:

Full-Time 1st Shift 

 

  • Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD-9-CM and/or ICD-10-CM, ICD-10-PCS and/or CPT-4 codes for billing, internal and external reporting, research and regulatory compliance activities.
  • Resolve error reports associated with the billing processes, identify and report error patterns and when necessary assist in the design and implementation of work flow changes to reduce billing errors.
  • Must meet ongoing productivity and quality metrics as established within the department for each level.
  • Coder may work remote if minimum technology requirements, productivity and quality requirements are met and they sign, and adhere to, the Telecommuter Work Agreement.

 

 

Level I:

· Identifies chargeable items and facility level for emergency department visits, including observation services, and enters them into billing system.

· Meet and/or exceed the established quality standard of 95% accuracy rate or better while

meeting and/or exceeding established production standards.

-OR-

· Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-9-CM , ICD-10-CM and CPT-4 procedures.

· Assigns codes for diagnoses and treatment according to the appropriate classification system for ancillary outpatient encounters, including modifier assignment.

· Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.

 

Level II:

· Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-9-CM , ICD-10-CM and CPT-4 procedures.

· Assigns codes for diagnoses, treatment and procedures according to the appropriate classification system for Outpatient and Emergency Department encounters, including modifier assignment.

· Identifies chargeable items and facility level for emergency department visits, including observation services, and enters them into billing system.

· Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.

 

Level III:

 

· Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-9-CM , ICD-10-CM and CPT-4 procedures.

· Assigns codes for diagnoses, treatment and procedures according to the appropriate classification system for Outpatient ancillary and Emergency Department encounters, including modifier assignment.

· Reviews professional and hospital inpatient and outpatient surgery medical record documentation and properly identifies and assigns ICD-9-CM, ICD-10 CM, and/or CPT-4 codes for all reportable diagnoses and procedures.

o Determines the correct principal diagnosis, co-morbidities, complications, secondary conditions and surgical procedures.

o Assigns MS-DRG

o Assigns Present on Admission (POA) indicators

o Identifies HAC (Hospital Acquired conditions) and when required, report through established procedures.

o Accurately abstracts Discharge Disposition code.

o Queries physicians per established policy and procedure when documentation is not clear or conflicting.

· Meet and/or exceed the established quality standard of 95% accuracy rate or better while meeting and/or exceeding established production standards.

· Keeps abreast of coding guidelines by self-study, assigned education, coding meeting attendance or related in-services. Participates in internal and external quality review meetings.

· Performs other duties as assigned.

 

Education, Training and Experience

 

Level I:

  • Required: High school diploma or equivalent. Two years of hospital acute care OP diagnostic coding experience.
  • Preferred: Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT and/or RHIA. CPC and/or CPC-H will be considered with relevant outpatient coding experience.

 

Level II

  • Required: Two years of progressive hospital acute care coding experience including ER , outpatient procedure and same day surgery. Successful completion of a certified coding program. Credentials to include one or a combination of the following: CCA, CCS, CCS-P, RHIT and/or RHIA. CPC and/or CPC-H will be considered with relevant outpatient coding experience.

 

Level III

  • Required: Five years or greater of progressive inpatient (IP) coding experience in an acute

care facility. Credentials to include one or a combination of the following: RHIA, RHIT, and/or CCS.

  • Preferred: Academic or level I or II trauma center experience. Two years of progressive OP diagnostic and emergency room coding experience.

 

Skills or Other Qualifications

 

Required: 

  • Ability to code and maintain corporate/department specific quality standards

and meet productivity standards as documented by the department and

organization.

  • Knowledge of medical terminology, anatomy and physiology,

disease process and minor surgical procedures.

  • Knowledge of accepted medical abbreviations and their meanings.
  • Knowledge in the use of specialized references such as the ICD-9-CM and CPT-4 books, medical dictionaries and

texts, and medical journals.

  • Must have extensive knowledge of Coding Clinic, CPT Assistant, and all official coding guidelines.
  • Advanced knowledge of hospital information systems, encoders and other technology to facilitate a

successful virtual work environment while maintaining maximum communication and adhering to HIPAA security standards.

  • Advanced knowledge of MS Excel, Word and Outlook functions.
  • Abides by the standards of Ethical Coding as set forth by the American Health information Management

Association (AHIMA) and adheres to all official coding guidelines.

  • Technical skills required to learn and navigate a variety of software systems, trouble-shoot

computer problems, install periodic updates to software programs and work

efficiently in a virtual environment.

  • Strong written and verbal communication skills.
  • Ability to think/work independently, yet interact positively with a remote team.
  • Advanced problem-solving skills. Familiarity with current healthcare based technology, coding, and Electronic Health Record (HER).
  • Attention to detail is crucial to this position.

 

Preferred: 

  • Knowledgeable in Revenue Cycle department functions relating to Ambulatory Payment Classification (APC) grouping, denials and edits.


Nearest Major Market: Orange County
Nearest Secondary Market: Los Angeles

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