Coder Senior

The Coding Senior will be responsible applying the appropriate ICD-10-CM/PCS and CPT diagnostic and procedural codes and determining the MS-DRG and APR-DRG assignment of in patient records across multiple specialties (cardiology, cardiothoracic surgery, trauma, orthopedics, general medicine and surgery, pediatrics, obstetrics, newborns, etc.) or applying the appropriate ICD-10 diagnostic and CPT procedure codes for ambulatory records across multiple specialties (i.e. family medicine, internal medicine, cardiology [IR], cardiothoracic surgery, interventional radiology, trauma, orthopedics, general surgery, urology, gynecology, etc.). The Coding Senior may be assigned any of the coding functions of a Coding Specialist I.

Your Everyday

• Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs assignment and all required modifiers.
• Validates charges by comparing charges with health record documentation as necessary.
• Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.
• Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.
• Tracks issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.
• Consistently meets or exceeds coding quality and productivity standards established by coding department.
• Adheres to LCMC confidentiality requirements as they relate to release of any individual or aggregate patient information.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Performs other duties as assigned by leadership.
• Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the 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.

The Must-Haves

EDUCATION/EXPERIENCE QUALIFICATIONS

• Required: High School Diploma/GED or equivalent and 3 years of work experience, or Associate’s and 1 year of experience, or Diploma/Certification in Coding and 1 year of experience.
• Preferred: Associate's Degree in HIM or similar or Completion of AHIMA Approved coding program or AAPC coding program.

Preferred:

LICENSES AND CERTIFICATIONS

A certification in the following areas is also preferred:

• Registered Health Information Technician from the Commission on Certification for Health Informatics and Information Management (CCHIIM)- AHIMA
• Registered Health Information Administrator from the Commission on Certification for Health Informatics and Information Management (CCHIIM)- AHIMA
• Certified Coding Specialist from the Commission on Certification for Health Informatics and Information Management (CCHIIM)

KNOWLEDGE, SKILLS, AND ABILITIES

• Comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding and MS-DRG or APC grouping and components of charge description master for charging functions.
• Must possess knowledge of third party reimbursement regulations and billing practices.
• Experience utilizing encoding/grouping software.
• Ability to use standard desktop and windows based computer system, including basic understanding of email, internet, and computer navigation.
• High ethical standards.
• Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
• Experience in ICD-10-CM/PCS coding and reimbursement training.
• Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
• Knowledge of hospital and professional coding including provider-based billing.
• Knowledge of documentation regulations of Joint Commission and CMS.
• Experience with concurrent coding reviews.
• Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
• Experience in assisting and identifying learning needs as well as providing training to coding staff.
• Strong analytical abilities and problem-solving skills.
• Excellent oral, written and interpersonal communication skills.
• Ability to organize and set priorities to ensure objectives are met in a timely manner.
• Ability to adapt to change and handle challenges proactively and with pose.
• Ability to effectively collaborate with physicians and managerial staff at all levels.