Hospital for Special Care 2150 Corbin Ave New Britain Connecticut 06053 United States
Feb 06, 2019Full-time
QUALIFICATIONS Required: Associate’s degree in Health Information Management or equivalent from two-year college. Minimum 3 years coding inpatient and clinic/physician-based records in acute hospital setting. Years of experience in coding may be considered as substitute for education. Must have completed and passed a formal ICD-10 Education program. Required: Certified Coding Specialist (CCS) or Certified Coding Specialist – Physician-based (CCS-P), or Certified Professional Coder-Payer (CPC-P), or able to achieve certification within 2 years of hire. Required: Registered Health Information Technician (RHIT) certification is a plus. Required: Ability to read, analyze, interpret ICD-9, ICD-10, CPT, HCPCS and Modifer books. JOB SUMMARY Responsible for the coding and facility charge process for both outpatient coding and inpatient coding. Abstracts clinical information from medical records and assigns appropriate ICD 10 diagnoses and procedure codes as appropriate and CPT modifiers according to coding guidelines and established procedures. Educates both medical and clinical staff on appropriate documentation practices, DRG assignment and changes in assignments, modifier usage, changes in software upgrades and communicates guidelines as published by regulatory agencies. Works closely with clinical documentation improvement initiatives and patient accounts to ensure documentation accurately reflects patient acuity for services rendered. ESSENTIAL FUNCTIONS Ensures that coding processes can be completed timely and efficiently on both outpatient and inpatient discharged accounts. Working with HIM and other staff to identify and resolve outstanding accounts through to revenue cycle. Uses EMR, paper record and clinical documentation tool to assign all diagnostic, procedure and facility based charging in a timely manner. Monitors record completion and assembly processes to ensure that records are available timely for coding. Codes principal diagnosis and secondary diagnosis accurately using ICD-10 classification system within 24 hours of inpatient and outpatient admission, and enters codes into hospital information management system to ensure proper admission DRG assignment for inpatients following published guidelines. Analyzes any/all physician/clinical documentation to determine appropriate diagnosis code assignment and accurately assigns ICD diagnoses and procedure codes for all patients as appropriate on admission, concurrently throughout stay and discharge. Notifies clinical and other support staff with changes in DRG assignment, as appropriate, if different from admission DRG. Queries physicians as needed for documentation clarity. Participates on Outpatient Revenue Cycle Committee and appropriate individuals for review and assignment of correct CPT codes. Works in collaboration with others to ensure proper use of modifier assignment to CPT codes for inpatient and outpatient procedures or services. Performs quarterly and monthly audits using predefined criteria for inpatient accounts based on DRG, ICD, CPT Evaluation/Management coding assignments and provider documentation review. Follows up with providers for any records which cannot be completed for lack of documentation or clarification. Distributes coding queries as appropriate. Provides information/training to clinical staff and providers on changes in coding practices such as ICD-10, CPT and modifiers, appropriate documentation practices, and DRG assignments as needed. Assists with updating departmental coding policies and procedures. Serves as a resource for all hospital staff with questions related to Inpatient ICD 9/10 coding, CPT modifier and DRG assignments. Confirms patient charges from outside facilities or ambulance companies for the Fiscal Department within five days of receipt, for billing processes. Is responsible for monitoring and correcting the “Doc-Dup” report daily/weekly/monthly and prior to bills dropping. Maintains ICD-9-CM and ICD-10 coding books, updating manual as new subscriptions are received to guarantee codes are current for appropriate reimbursement. May assist the Quality Department by conducting timely reviews for quality assurance for appropriate medicine departments, as well as review of special studies for Misc. dept., as delegated, and tabulates individual physician QA for the credentialing process. Maintains knowledge of Federal, State, and JC standards of documentation regulations and guidelines to ensure understanding and quality analysis of documentation.