Lead HIM Hospital Coder/Auditor (In-Patient - Observation)

Position Summary / Career Interest:

The Health Information Management (HIM) Inpatient/Observation Hospital Coder Auditor/Lead responsibilities include reviewing all diagnosis and procedural coding in ICD-10-CM/PCS for accurate DRG assignment. This position will have daily interactions with internal and external customers to include physicians, hospital support services and ancillary departments. The HIM Inpatient/Observation Hospital Coder Auditor/Lead will perform inpatient/outpatient coding compliance audits and provide coder education. This position will assist in the preparation and finalization of auditing reports.


Responsibilities and Essential Job Functions

• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• Note:  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.
• Monitors coding compliance and case mix comparison for select outpatient, same day surgery and inpatient accounts. Works in conjunction with the Clinical Documentation Improvement (CDI) team to provide for comprehensive medical record documentation and to achieve accurate DRG assignment and appropriate mortality and severity scores.
• Validates HIDI, KHA and other external data reporting accuracy, while obtaining target coding trends for improvement.
• Completes focused record reviews based on benchmarking data from UHC and other quality reports quarterly
• Identifies unspecified diagnosis used and determine if documentation supports a more specific diagnosis.
• Works with Coding Supervisor/Manager on record review projects.
• Provides coding expertise for data reporting activities while employing all federal regulations and coding guidelines.
• Provides education/training to physicians and other providers on coding and DRG assignment.
• Reviews the complex (problematic coding that needs research and reference checking) medical records and accurately codes the primary/secondary diagnoses and procedures using ICD-10-CM/PCS coding conventions.
• Maintain 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.
• Provides high-level analysis of trends to Management, Revenue Managers and others about Coding related issues
• Researches and identifies trends in unbilled accounts
• Coordinates quality reporting measures with Providers, Revenue Managers and Management
• Assist supervisor in training new hires and other coders within the department.
• Performs audits on coding accuracy and/or DRG assignment to comply with corporate compliance responsibilities to include RAC and insurance revision requests and appeals.
• Prepares materials for presentation for continuing education to applicable internal and external customers.
• 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 related field of study from an accredited college or university.
• 5 or more years of coding experience in inpatient and/or outpatient ICD-10 CM/PCS.
• 1 or more years of auditing experience utilizing ICD-10 CM/PCS.

Preferred Education and Experience

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

Preferred Licensure and Certification

• CIRCC, CCS-P or RCCB certification.

Required Language Skills

• Fluent English - Must be able to read, write, and speak English.

Knowledge Requirements

• Expertise in MS-DRG Optimization, APR DRG, RAC/HAC/Core Measures.
• Coding accuracy: 95% or better in accordance with HIM Quality Analysis Policy.

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.