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The purpose of this position is to assign ICD-9-CM diagnosis and procedure codes with the appropriate DRG assignment for inpatient encounters, ICD-9-CM diagnosis and procedure codes, CPT-4 procedure codes, and APC assignment for outpatient encounters. This is to ensure a valid database used for research, reporting, quality improvement activities, reduce days not final billed (DNFB), and appropriate reimbursement.
Scope
Assigns ICD, CPT and HCPCS coding classifications based on clinical documentation and / or physician orders. Utilizes appropriate tools, resources and guidelines to determine codes and assigns first listed diagnosis and secondary diagnoses. Obtains clarification from physicians, clinical departments and others on documentation questions, as needed. Performs coding at an advanced level of coding complexity. Codes complex diagnoses, CPT and assigns modifiers for multiple facilities. Codes combinations of outpatient hospital charts.
Maintains assigned work queues within defined processing timeframe and meets or exceeds productivity standards.
Verifies data abstracted and entered from the EMR. Ensures integrity of the database for internal and external data reporting.
Responds in a timely manner to inquiries from Revenue Services related to use of codes and modifiers within the billing process to assure accuracy and avoid delays in the billing process.
Adheres to all compliance guidelines, both internal and external. Participates in continuing education programs to maintain an understanding of anatomy, physiology, medical terminology, disease processes and surgical techniques to support the effective application of coding guidelines and maintain credentials.
Promotes mission, vision, and values of SCL Health, and abides by service behavior standards.
Performs other duties as assigned.
Minimum Qualifications Required
High School Diploma or equivalent
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), OR certified Coding Specialist (CCS) credential through American Health Information Management Association (AHIMA) OR completion of coding certification through American Academy of Professional Coders (AAPC) with coding certification of Certified Professional Coder (CPC) or Certified Outpatient Coder (COC) or Certified Inpatient Coder (CIC) or Certified Coding Associate through AHIMA (CCA) required
Preferred Associate Degree in Health Information or in a Healthcare related field
Minimum of three years coding experience in a hospital or acute care setting is required, using both ICD and CPT coding preferred