HIM Coder III

SUMMARY:

Provides timely and accurate administrative and clinical data through the accurate assignment of current ICD-10-CM/PCS, CPT or HCPCS 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 services.

ESSENTIAL FUNCTIONS:

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

Responsible for accurately coding inpatient or outpatient record types. For outpatient, must be able to code a minimum of four of the following independently: emergency, same day surgery, observation, pain clinic, wound clinic, diagnostics and recurring accounts.

Follows departmental and current official coding guidelines to ensure consistent and accurate coding of diagnostic and procedural data.

Utilizes the 3M 360, 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 DRG/APC questions.

Determines the sequence of diagnoses according to UHDDS (Uniform Hospital Discharge Data Set) standards.

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. Achieves average weekly utilization productivity of 95% of standard.

Reviews charts that have been returned by payers for challenges.

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. Preferred is the completion of a 4-year college curriculum in Health Information Management.

EXPERIENCE: Five (5) years of acute care hospital coding experience required.

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

KNOWLEDGE, SKILLS AND ABILITIES: 

• Knowledge of current ICD-10-CM and ICD-10-PCS codes, APC reimbursement models, UHDDS sequencing and DRG payment methodologies, including both MS-DRGs and APR-DRGs.
• 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.