DRG​/APC Coordinator - Health Information Management - Providence Hospital

Overview

USA Health is Transforming Medicine along the Gulf Coast to care for the unique needs of our community. USA Health is changing how medical care, education, and research impact the health of people who live in Mobile and the surrounding area. Our team of doctors, advanced care providers, nurses, therapists, and researchers provides the region's most advanced medicine at multiple facilities, campuses, clinics, and classrooms.

We offer patients convenient access to innovative treatments and advancements that improve the health and overall well-being of our community.

• The DRG / APC Coordinator's department responsibilities:
  • Requires minimal supervision to safely perform all responsibilities.
  • Maintains a clean and secure workstation.
  • Utilizes and accesses the Hospital Information System (Cerner), 3M / Solventum, Vincari and any other applicable computer applications as assigned.
  • Analyzes Medicare / DRG Payer inpatient records and assigns the correct ICD-10-CM diagnosis and ICD-10-PCS procedure codes, for optimal reimbursement. Analyzes Medicare / APC / EAPG Payer outpatient and emergency room records and assigns the correct ICD-10-CM diagnosis, ICD-10-PCS procedure codes and the correct CPT or HCPCS procedure codes, for optimal reimbursement.
  • Assures the diagnoses and procedures coded have been documented in the medical record by the physician.
  • Develops and assigns provider Coding Queries when documentation clarification is needed in order to assign the most accuratce and appropriate code.
  • Properly identifies the principal diagnosis, secondary diagnoses and any procedure codes as required by CMS.
  • Reviews all coding denials and audits, determines proper course of action and end effectively communicates and / or completes the action(s) necessary for resolution.
  • Communicates with Hospital Business Office to answer questions concerning coding and billing issues and performs any follow-up as needed.
  • Keeps the Coding Manager informed of problems and / or concerns.
  • Refers all coding software problems to Coding manager promptly for resolution.
  • Stays informed about coding changes and updates through the review of the Federal Register, CMS websites, publications such as the Coding Clinic and CPT Assistant, etc.
  • Must be able to accurately code a minimum of 2 to 3 Medicare / DRG Payer inpatient records per hour and a minimum of 5 outpatient surgery / outpatient in a bed / outpatient / observation records per hour or 12 emergency room records per hour.
  • Works with the medical staff, CDI, social services, nursing, ancillary care staff, discharge planning, utilization review and care managers concerning documentation requirements and the correct assignment of all coding, including severity of illness and risk of mortality.
  • Actively reviews and works all coding queues as assigned by the Coding Manager to ensure the oldest accounts are coded first such that all records are coded within five days of discharge.
  • Attends and / or assists the Coding Manager with coding meetings related to HACs, PSIs, PDIs, etc.
  • Performs related duties as assigned.
• The (DRG/APC Coordinator) documentation responsibilities:
  • Maintains accurate and complete records.
  • Accurately assigns coding "holds" when documentation needed for coding is missing.
  • Maintains accurate logbooks / spreadsheets.
  • Updates Cerner / Solventum (3M) information as needed.
• The (DRG/APC Coordinator) citizenship responsibilities:
  • Accepts and completes all duties positively and without conflict.
  • Cooperates, helps others and improves the performance of the coding department.
  • Completes all mandatory unit, educational and hospital requirements.
  • Utilizes cost effective practices in performing all aspects of the job.
  • Adheres to current Infection Control and Safety Standards.
• OTHER
  
  DUTIES AND RESPONSIBILITIES:
  • Other duties as assigned / required.
  • Participates on committees and / or ad-hoc groups as assigned.
  • Participates in Performance Improvement activities as assigned.
• The (DRG/APC Coordinator) professional responsibilities:
  • Abides by and enforces all compliance requirements and policies and performs these responsibilities in an ethical manner consistent with the organization's…