The Coding Specialist II 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 surgery records across multiple specialties (i.e. cardiology [IR], cardiothoracic surgery, interventional radiology, trauma, orthopedics, general surgery, urology, gynecology, etc.). The Coding Specialist II may be assigned any of the coding functions of a Coding Specialist I.
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 above statements reflect the general duties considered necessary to describe the principal functions of the job as identified and should not be considered a detailed description of all the work requirements that may be inherent to the position.
REQUIRED 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.
Education: Completion of an American Health Information Management Association (AHIMA) approved coding program or an American Academy of Professional Coders (AAPC) approved coding program, or Associate degree in health information management or related field or an equivalent combination of years of education and experience required.
Experience: Minimum two (2) years of current complex outpatient and inpatient coding required.
Certification/Licensure: Certified Coding Associate (CCA) from American Health Information Management Associations (AHIMA) or Certified Inpatient Coder (CIC) and Certified Outpatient Coder (COC) combination from or American Academy of Professional Coders (AAPC) required. RHIA/ RHIT, Certified Coding Specialist (CCS) certification preferred. Internal staff who are not certified must obtain medical coding certification within twelve months through an approved LCMC coding program.
Instructions for Resume Submission:
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Apply Online: https://pm.healthcaresource.com/cs/touro/#/job/21856