HIM Inpatient/Observation Hospital Coder

Position Summary / Career Interest:

The Health Information Management (HIM) Inpatient/Observation Hospital Coder is responsible for coding inpatient health records. Responsibilities include diagnosis and procedural coding utilizing CD-10-CM/PCS for accurate DRG assignment. They will have daily interactions with internal and external customers to include physicians, hospital support services and ancillary departments.

Responsibilities and Essential Job Functions

• Abstracts clinical data from health records and assigns appropriate ICD-10 CM and ICD-10 PCS codes. These codes are used for classification, reimbursement, strategic planning, and research.
• Works Collaboratively with the clinical documentation program to achieve accurate DRG assignment and appropriate mortality and severity scores.
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM/PCS coding guidelines to inpatient and outpatient diagnoses and procedures.
• Correlates information from approved supporting clinical documentation not limited to Pathology, Radiology and/or other Physician Consultations after review by the Attending Physician, wherever appropriate.
• Abstracts all clinical data with a high degree of accuracy to utilized in research and benchmarking by the hospital, UKP, and the University as well as numerous third parties such as UHC, KDHE, HIDI and CMS
• Communicates with nursing and ancillary services personnel for needed documentation for accurate coding.
• Provides real-time feedback to surgical/procedural providers as it pertains to proper coding and clinical documentation of services performed
• Maintains and processes claim edits to assure timely billing
• Works collaboratively to achieve minimum bill days from discharge/ service date inpatient/outpatient accounts.
• Coders maintain prioritized workflow through cooperative work distribution (i.e. prioritization of charts by discharge date and total charges)
• Performs other related duties incidental to the work described herein.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• Associates Degree in a related field of study from an accredited college or university.
• 1 or more years of coding experience in inpatient and/or outpatient ICD-10 CM/PCS.
• Coding accuracy: 95% or better in accordance with HIM Quality Analysis Policy.

Preferred Education and Experience

• Bachelors Degree in a related field of study from an accredited college or university.
• 1 or more years of experience in Epic.

Required Licensure and Certification

• One of the following certifications is required from an accredited institution:
• Registered Health Information Administrator(RHIA) - American Health Information Management Association (AHIMA)
• Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA)
• Certified Coding Specialist - Physician Based (CCS-P) - American Health Information Management Association (AHIMA) OR
• Certified Coding Specialist - American Health Information Management Association (AHIMA)

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.