Coding Specialist
This position is responsible for accurately coding at least one main outpatient work type accounts (Observation, Same Day Surgery, and/or ER) as well as assisting with the coding of other outpatient work types as needed. All accounts should be completed within 5 days following discharge.
Position Requirements
Minimum Education Required: Completion of college level course work in Medical Terminology and Anatomy and Physiology. Preferred: Minimum education level of Associates Degree.
Minimum Work Experience Required: A minimum of two (2) years coding experience in an acute care hospital.
Required Licenses/Certifications Required: CCA credentials (Certified Coding Associate) or CPC credentials (Certified Professional Coder)
Required Skills, Knowledge, and Abilities Required: A thorough working knowledge of Medicare billing rules, regulations and local medical review policies as they impact reimbursement under APCs and DRGs.
Preferred Qualification Preferred: CCS credentials (Certified Coding Specialist -- Hospital based) Preferred: RHIT or RHIA credentials
Job Specific Functions
- Demonstrates an understanding of and adherence to the HMHD Compliance Plan.
- Conduct reflects HMHD's values and a commitment to HMHD's Code of Conduct.
- Attends the required corporate integrity and compliance training and education programs.
- Demonstrates proficiency in understanding the materials presented during the corporate integrity and compliance training and education program.
- Complies with all HIPAA standards.
- Responsible for final coding of outpatient accounts (Observation, Same Day Surgery and/or Emergency Department).
- Accurately assigns ICD-10-CM and CPT codes to arrive at an APC based on information provided in the patient record.
- For observation accounts, responsible for capturing ER E/M level charges, injections/infusions charges, and observation hour charges for patients that are admitted to observation.
- Prompts medical staff physicians for additional documentation as needed to clarify correct assignment of ICD-10-CM diagnosis and CPT procedure code assignment.
- Responsible for responding to any audited accounts provided by the Audit team within three (3) business days of receipt.
- Responsible for responding to Patient Financial Services (PFS) questions regarding coding assignments that generate errors within the billing editor within three (3) business days of receipt.
- Responsible for maintaining an overall coding accuracy rate of 95% or greater.
- Responsible for ensuring that no accounts remain un-coded > 5 days following patient discharge unless required documentation is needed.