HIM Coder Associate - Quality Assurance

SUMMARY:

Provides timely and accurate administrative and clinical data through the accurate assignment of current ICD-10-CM and CPT codes while complying with the regulations and requirements of the Federal Government, State licensing agencies and the Hospital’s policies and procedures. Supports TMCH’s management planning process and ensures appropriate reimbursement for outpatient services.

ESSENTIAL FUNCTIONS:

Assigns the correct ICD-10-CM and CPT codes to each diagnosis and operative procedure substantiated by documentation contained in the medical record utilizing the current code sets.

Responsible for accurately coding outpatient record types including but not limited to emergency department, surgery, observation, pain clinic, wound clinic, diagnostics and recurring accounts.

Follows departmental and current official ICD-10-CM and CPT coding guidelines to ensure consistent and accurate coding of diagnostic and procedural data.

Utilizes 3M, CAC (Computer Assisted Coding), Epic, and any other necessary applications for proper coding, ensuring accuracy.

Ensures that the medical staff documents have sufficient information for accurate coding and appropriate reimbursement, requesting clarification from the provider when information is incomplete. Assists physicians, their office staff, quality management and other hospital personnel with coding and APC questions.

Inputs abstract data and codes into computer to gather administrative and clinical data for distribution to outside regulatory agencies, third party payers, administrative staff and physicians.

Ensures that institutional policies and procedures for maintenance of medical records are followed.

Maintains current knowledge of coding principles and guidelines as coding conventions are updated.

Maintains a 95% coding accuracy rate and achieves average weekly utilization productivity of 95% of standard.

Participates in coding special accounts when necessary to ensure the smooth flow of the department.

Adheres to TMC organizational and department-specific safety, confidentiality, values, policies and standards.

Performs related duties as assigned.

MINIMUM QUALIFICATIONS

EDUCATION: Completion of a 2-year college or technical school curriculum in Health Information Management, or an equivalent combination of relevant education and experience.

EXPERIENCE: Demonstrated knowledge of current ICD-10-CM and CPT coding. Two (2) years experience in a Health Information Management department preferred.

LICENSURE OR CERTIFICATION: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Coding Specialist-Physician-based (CCS-P), Certified Professional Coder (CPC), Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) to be obtained within one year.

KNOWLEDGE, SKILLS AND ABILITIES: 

·       Knowledge of current ICD-10-CM, CPT codes, and APC reimbursement models.

·       Knowledge of medical terminology.

·       Skill in the coding of medical information and maintaining databases to ensure accuracy.

·       Skill in organizing tasks to ensure the timely and accurate coding of information.

·       Skill in both oral and written communication. 

·       Ability to read, analyze and interpret professional journals, governmental regulations, and coding  

guidelines.

·       Ability to follow written and verbal instructions.

·       Ability to maintain good working relationships and communication with the medical staff, nursing, administration, and other ancillary departments with the hospital.

·       Ability to perform multiple tasks and ensure completion to meet strict deadlines.