Coder lll -Inpatient Coder

Insight Hospital and Medical Center Chicago

At Insight Hospital and Medical Center Chicago, we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients.

Be a part of the Insight Chicago team that provides patient care second to none!

Provides high level technical competency and subject matter expertise analyzing physician/provider documentation contained in assigned Complex Outpatient (CO) and/or Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Provides appropriate Medical Severity Diagnostic Related Groups (MS-DRG), Present on Admission (POA), Severity of Illness (SOI) & Risk of Mortality (ROM) assignments for Inpatient records and accurate APC assignments and all required modifiers for Complex Outpatient records.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, Current Procedural Terminology (CPT) /Healthcare Common Procedure Coding System (HCPCS) procedure codes, MS-DRG, POA, SOI & ROM assignments and assignment of APC's and all required modifiers.

Assigns appropriate code(s) by utilizing coding guidelines established by:

• The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting
• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
• American Medical Association (AMA) CPT Assistant for CPT codes
• American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Revenue Excellence/RHM Organization coding policies

• Knows, understands, incorporates, and demonstrates the Insight Hospital Mission, Vision, and Values in behaviors, practices, and decisions.
• Adheres to Insight Health confidentiality requirements as they relate to the release of any individual or aggregate patient information.
• Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.
• Codes Complex Outpatient or Inpatient utilizing encoder software and online tools and references, in the assignment of ICD, CPT, HCPCS codes, MS-DRG, POA, SOI & ROM assignments, APC assignment and all required modifiers.
• Consults reference materials to facilitate code assignment.
• Understands appropriate link of diagnosis to procedure.
• Appends modifier(s) to procedure code or service when applicable.
• Collaborates with HIM and Patient Financial Services in resolving billing and utilization issues affecting reimbursement.
• Interprets bundling and unbundling guidelines (NCCI).
• Interprets LCDs/NCDs and payer policies.
• Tracks issues (i.e., missing documentation, charges or Inpatient queries that require follow-up to facilitate coding in a timely fashion).
• Investigates claims denials and/or appeals as directed.
• Consistently meets or exceeds coding quality and productivity standards.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Identifies concerns and responsible for providing…