Coder III : Medical Coding

Coder

The Coder reviews clinical documentation and diagnostic results and applies appropriate ICD-10-CM, ICD-10-PCS, and CPT codes to support diagnoses, procedures, and treatment results. Codes are used for billing, internal and external reporting, research, and regulatory compliance activities. 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.

Verifies that all ICD-10-CM and CPT codes are correctly captured.

Verify that physician is correctly abstracted.

Keeps abreast of coding guideline changes 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.

Resolves billing related errors and assists with workflow changes and process improvement projects.

Meets ongoing productivity and quality standard of 95% accuracy rate or better.

Additionally, the Coder III assigns codes for diagnoses, treatment, and procedures for inpatient surgeries.

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

Abstracts correctly all required information from record including the correct discharge disposition and OSHPD required information.

Also assigns correct MS-DRG and APR-DRG and correct Present on Admission (POA) indicators and identifies (HAC) Hospital Acquired Conditions.

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

Meets ongoing productivity and quality standard of 95% accuracy rate or better.

The coder follows all coding conventions and serves as a coding consultant to Hoag providers.

Discrepancies are identified that may impact quality of care and/or billing issues.

The coder will serve as a resource and subject matter expert to other coding staff.

Completes coding charge review and claim edits in Epic or other appropriate EMR system which would entail coding and correcting ICD-10 codes, modifiers, and CPT E/M and procedure codes.

Reviews and communicates with providers on E/M Leveling/Coding.

Codes specialty specific outpatient surgeries/same day procedures.

Qualifications

Education and Experience

High school diploma or equivalent required.

Medical Coding - Hoag Hospital:

• Completion of a certified coding program or graduate of a CAHIM accredited HIT program required.
• Five years of progressive inpatient coding experience in an acute care facility.

Coding - Hoag Clinic: Required:

• Five or more (5+) years coding experience mastering assigning diagnostic and procedure codes to patient medical records.
• Must have extensive outpatient coding experience in multiple areas of specialty.

Preferred:

• Adept coding experience (CPT/ICD-10-CM) in multiple specialties to include but are not limited to: OB/GYN, Urology, Oncology, Pain Management, Cardiology, Neurology, and Orthopedics.
• Knowledge of E/M coding related to multi-specialty providers.
• Knowledge of the elements of disease processes and related procedures.
• Strong clinical knowledge and understanding of pathology / physiology of disease processes.
• Excellent interpersonal skills to build effective partnering relationships with physicians, nurse staff and hospital management staff with the ability to facilitate ongoing physician communication and able to work independently in a time-oriented environment.
• Experience working in EPIC- EMR.

License Required

N/A

Certifications Required

Medical Coding - Hoag Hospital: Certified Coding Specialist (CCS)

Coding - Hoag Clinic:

• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Coding Specialist Physician-Based (CCS-P)
• Certified Coding Specialist (CCS)
• Certified Professional Medical Auditor (CPMA)

Cath Lab / IR:

One of the following Certifications:

• Certified Professional Coder (CPC)
• Certified Coding Specialist (CCS)
• Certified Interventional Radiology Cardiovascular Coder (CIRCC)

Certifications Preferred:

Coding - Hoag Clinic: Certified Urology Coder (CUC)