Medical Coder II, Inpatient Hospital Full Time

All employees must be a resident of CT, MA, or NY to work for CT Children's The purpose of this position is to apply the appropriate diagnostic and procedural codes to individual health information for data retrieval, analysis, and claims processing. The DRG coder creates consistency and efficiency in inpatient claims processing and data collection to optimize DRG reimbursement and facilitate data quality in hospital inpatient services. The coder abstracts pertinent information from patient records and assigns ICD-9-CM/ICD-10-CM, ICD-10-PCS or CPT/HCPCS codes, creating APC or DRG group assignments. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. The coder keeps abreast of coding guidelines and reimbursement reporting requirements. Brings identified concerns to supervisor or department manager for resolution. Abides by the standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Documentation assessment and review for accurate abstracting of clinical data to meet regulatory and compliance requirements. The coder assists in coordination of the compilation of data relative to regulatory agencies and the accreditation process. Review all charges, ensure accurate charge capture and review medical necessity for all ordered tests/procedures. Perform coding and charge capture for facility services including but not limited to emergency department and IV services. Charge capture may include providers' services. Monitor coding work queues for simple visit coding including rehabilitation services. Proactively communicate with physicians and physician's offices to insure adequate documentation to support ordered services. Verify accuracy of patient account/type and demographic data and coordinates with patient financial services to assure accurate billing/reimbursement and reporting. The coder displays initiative and supports continuous quality improvement efforts. He/she performs special projects, training, education, and/or other duties as assigned. Continuously evaluate the quality of clinical documentation to spot incomplete or inconsistent documentation for inpatient encounters that impact code selection and resulting DRG groups. Monitor unbilled account reports for outstanding or uncoded discharges. Reviews bills and payments to insure correct billing and reimbursement. Audits, corrects, and submits any denials as appropriate. Possess knowledge and understanding of discharge, not final billed (DNFB) parameters. Abstracts data for special projects and quality initiatives Effectively uses of software to follow through on accuracy of claim submission. Effectively communicates with patient financial services to resolve coding and billing questions or concerns. Experience Preferred: Successful completion of a coding certificate program with AHIMA approval status preferred. Education Required: Associate degree or equivalent training acquired through at least three years on-the-job experience. Certification is required within one year of hire; acceptable certifications for this position include: American Health Information Management Association (AHIMA): RHIA, RHIT, CCS, CCS-P, CCA American Academy of Professional Coders (AAPC). Knowledge, Skills and Abilities: Knowledge of: Coding guidelines for using ICD-9-CM (Volumes 1, 2, and 3), ICD-10-CM, ICD-10-PCS, CPT and HCPCS Level II codes in inpatient and outpatient settings. Extensive knowledge of anatomy and medical terminology. Maintains, and increases knowledge of issues that affect coding and billing and the healthcare industry. Regulatory requirements pertaining to healthcare operations in the practice and hospital settings. ICD-9-CM (Vol 1, 2, and 3) Official Coding Guidelines. ICD-10-CM Official Coding Guidelines. ICD-10-PCS Official Coding Guidelines. CPT and HCPCS Level II Coding Guidelines including Evaluation & Management Coding, Surgical Coding, and the use of Modifiers. Data management techniques. Skills: Advanced Computer skills, PC experience w/ Windows-based applications. Communication skills including strong verbal, written, and interpersonal skills. Keyboarding skills with ability to type 40 wpm minimum. Ability to: Analyze complex medical records and identify billable services. Work with individuals at all levels within the organization and the community; effectively communicate with providers. Manage and prioritize workloads to meet deadlines. Research coding questions. Gather, review and compile information and prepare reports, often with deadlines. Maintain quality and compliance standards. Maintain confidentiality of information. Function in a fast-paced environment with strong attention to detail meeting productivity and accuracy standards.