Coder Reimbursement Specialist - Hospital

Coder Reimbursement Specialist - Hospital

• Full-time

The Coding and Reimbursement Specialist, CCS is responsible for coding and abstracting thoroughly, clinical data from the medical record. This includes both inpatient, outpatient, commercial, Medicare, Medicaid, and Illinois Public Aid, plus any other payor types. This accurate and timely coding is essential for reimbursement to the hospital, according to the appropriately selected principal diagnosis, grouped to the DRG in accordance with rules and regulations and coding methodologies, resulting in reimbursement and billing compliances as set forth by the Office of Inspector General.

Manages workload and assigns work to three inpatient and two outpatient coders and oversees the day to day workings of the coding/reimbursement area. Monitors various regulatory sources to keep HIM coding and other staff informed and trained on various coding rules, regulations and related issues. Works closely with patient financial services to resolve any claim denials. Assists in updating the charge master.

Educates physician staff on documentation requirements to support E/M codes assigned to claims. Periodically audits the accuracy of all coding, including physician E/M, compared to the documentation in the record. Participates in various medical center billing, coding and compliance related groups. Works closely with physicians to document and interpret documentation and care of the patient. Works with Director in hiring and firing and evaluation of the coding staff.

Has input into systems and change of processes to maintain a current status. This position is directly related to the reimbursement the institute receives through skill, accuracy and keen job knowledge.

This position must be proficient in CPT, ICD-9-CM, E/M coding methodologies and the DRG and APC reimbursement system.

Other Skills and/or Knowledge

Required:

Proficient in CPT, ICD-9-CM, E/M coding methodologies and the DRG and APC reimbursement system. This position must be able to teach, train, and work with various coding systems.

Codes diagnoses and procedures ICD-9-CM, CPT, E/M coding methodologies. Is extremely proficient in all areas of coding and coding compliance and processes. Is able to code proficiently all types of patient records according to payor, Medicare, Commercial, Medicaid, Illinois Public Aid and any and all payor types. Carefully sequences principal and secondary diagnoses for appropriate and compliant reimbursement. The record is thoroughly reviewed for documentation, test interpretations, coded and processed using the computer software in the encoder for determination of the most appropriate and compliant reimbursement.

This is done according to the rules and regulations and guidelines of payors such as Medicare, Medicaid, etc. The Office of Inspector General has determined overall DRG or diagnosis specific focus. This position must be thoroughly knowledgeable in coding compliance and methodologies. Must maintain a current status in workload. Finished work compliant and accurate.

APC reimbursement system – Monitor systems and processes and is knowledgeable with APC reimbursement system. Works with the IS, business office and HIM staff, along with ancillary departments to facilitate information needed for coding and billing appropriately. This position works very closely with the medical staff, the Vice President of Medical Affairs, the Emergency Room Physicians, Medical Director and Director supporting their need for more thorough documentation and a better understanding of the coding policies and methodologies as it relates to their diagnoses.

Process payor record – Maintains daily interaction with coding staff to help process all types of payor record. Completes and works with evaluations, interviews, hiring, discipline, terminations, staff development through inservice, seminars and meetings. Attends continuing education to keep abreast of upcoming changes in regulations. Responsible for accounts not selected for billing list, inpatient, outpatient and miscellaneous for follow through, which involves retrieval, physician interaction.

This is in concert with benchmarking…