Coder II; Part Time

Category:

Administrative/Clerical

Description:

The Coder II reviews medical records, codes, abstracts and sequences all applicable diagnoses and procedures for all patient types, using the most accurate codes for reimbursement, research, epidemiology, statistical analysis outcomes, financial and strategic planning, evaluation of quality of care, and communication to support the patient’s treatment. The Coder II selects the most accurate and descriptive codes from the listings of International Classification of Diseases, Ninth Revision, Clinical Modification, ICD-10, American Medical Association Current Procedural Terminology (CPT-4) Coding system, and Healthcare Common Procedure Coding System (HCPCS) Must be able to work independently utilizing a computerized encoder and/or books and any other form of coding assistance as approved by Lewis County Hospital District No.

1. The Coder II has an in depth understanding of medical necessary. The Coder II works with new coders to ensure they are fully trained.

Maintains the confidentiality of medical records in accordance with state and federal requirements.

Minimum qualifications:

High School diploma or GED equivalent prefferred. Individual will be trained in ICD 10 CM and have an understanding of ICD - 10 CM, CPTAn Associate’s Degree in Health Information Management (RHIT), CCS, or CPC is preferred. AAPC certification required.

A minimum of five (5) years of inpatient/outpatient medical/surgical coding experience is required.

Well-rounded knowledge of medical terminology and anatomy & physiology is required. Ability to read, write, and communicate effectively is essential.

Primary job responsibilities:

Knowledge of medical terminology, abbreviations, anatomy and physiology; major disease processes and pharmacology.

Knowledge of classification systems, ICD-10-CM nomenclature, CPT-4 and HCPCS nomenclature coding rules, guidelines and proper sequencing.

Knowledge of Department of Health, HIPAA and other regulatory requirements impacting the quality and accuracy of medical records.

Maintains understanding of how to access coding tools such as Coding Clinic and CPT Assistant as well as other coding related references.

Coder will utilize Cerner for entering codes and abstracting.

Coder will be able to utilize the 3M encoder.

Coder will strive for an overall 95% accuracy rate for all patient types. Coder will be productivity standards which is 50 clinic or outpatient encounters in an eight hour period.

Coder will ensure accurate charge capture for all patient types.

Coder will complete assigned coding within the bill hold parameters defined by Arbor Health.

Ensures outpatient orders contain all required elements and concurrently reviews documentation, whenever possible, to ensure required elements for coding are present.

Utilization of the coding query process to providers to request missing information. Corrects records with inconsistent information and/or containing discrepancies.

Skill in reading medical records, and finding and resolving documentation discrepancies.

Maintains an understanding of reimbursement methodologies, e.g. CAH reimbursement, as well as DRGs, APCs and Value Based reimbursement.

Skill in effective verbal and written communication with peers, physicians and other hospital staff.

Maintains compliance with both external regulatory and accreditation requirements, and with State and Federal regulations.

Provides education and feedback to physician and professional staff regarding changes in coding methodology and documentation procedures.

Ability to perform analysis of medical records for completeness including signatures, required reports and other required information.

Verification of requests for health information and performance of release of…