Description
PRIMARY PURPOSE
The primary purpose of the Coding Specialist III is to code and verify data necessary to ensure correct coding, abstracting, and billing on inpatient (IP) encounters. This position requires the coder to be highly proficient in the proper assignment of ICD-10 CM, PCS, CPT, HCPCS. HCC, HEDIS CAT II and modifier codes for both professional and hospital charging, coding and billing. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland's policies to ensure accuracy of recorded patient medical information and appropriate reimbursement for services rendered.
Skills or Special Abilities
- Must be able to demonstrate advanced knowledge of ICD-9/ICD-10-CM/PCS coding and abstracting, MS-DRG classification and reimbursement structures, applicable coding edits and general knowledge of Local Coverage. Also prefer knowledge to apply CPT, HCPCS, HCC, HEDIS CAT II and modifier code assignment.
- Must score a minimum of 85% on a pre-employment coding test. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.
- Demonstrate knowledge of reimbursement (Medicare and Medicaid) principles.
- Advance knowledge of medical terminology, the human disease process, anatomy and physiology.
- Demonstrate good organizational and leadership skills.
- Must be able to effectively communicate, both orally and in writing.
- Demonstrate knowledge of computer software applications including MS Office and Computer Assisted Coding (CAC).
- Knowledge of Epic EHR and 3M 360 coding and abstracting software is preferred.
Responsibilities
1. Assigns appropriate principle and secondary diagnosis and procedures codes for all episodes of care on inpatient encounters ensuring appropriate DRG assignment according to ICD-10-CM/PCS conventions, guidelines and hospital policy.
2. Achieve and maintain 95% accuracy on quality reviews and meet assigned productivity standards.
3. Abstract statistical data from the medical record and enter information according to Parkland's guidelines, policies and procedures
4. Demonstrate knowledge of billing, charging and coding requirements for governmental guidelines and private insurance payers. May verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.
5. Coach other coders by training and advising on coding and abstracting according to ICD-10-CM/PCS conventions and guidelines, responding to coding inquiries, reviewing and noting coded charts, providing feedback and monitoring chart corrections to ensure that noted changes have been made to facilitate coding consistency, accuracy, efficiency and appropriate billing and reimbursement.
6. Contributes with work flow, priorities for work completion, and communicating workflow issues to the supervisor. Identifies ways to improve work processes and improve customer satisfaction. Make recommendations to supervisor, implements and monitors results as appropriate in support of the overall goals of the department and Parkland.
7. Collaborates with physicians and nurses by telephone or in writing to clarify or complete records by obtaining missing diagnoses, procedures or information, resolving ambiguous coding episodes to ensure that missing information is corrected and resubmitted for payment.
8. Facilitate a positive working relationship with management, coders, physicians, nurses, medical staff, COPCs, Financial Control, Business Services and hospital employees, to ensure that medical record information is documented and coded according to established conventions and Parkland's policies and guidelines.
9. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the coding and abstracting of medical records. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
10. Audits error reports and maintains departmental quality standards, prepares and submits productivity logs to supervisor, as required.
11. Stays abreast of the latest developments, advancements, and trends in the field of coding and abstracting of health information management by attending workshops, reading professional journals, actively participating in professional organizations, and integrates knowledge gained into current work practices.
12. Maintains CE hours and renew annual coding credentials.
13. Routine Screenings/Proof of Immunizations Exclusions: Virtual workforce employees as defined by Parkland's Virtual Work procedure, and as specified in their job descriptions, are not required to undergo routine screening for communicable diseases including TB, the flu vaccination, or the COVID-19 vaccination.
Job Accountabilities
1. Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
2. Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3. Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.
Requirements
MINIMUM SPECIFICATIONS
Education
- High school diploma required.
- Must have successfully completed an approved coding program.
- OR Must be a graduate of a health Information Management program.
Experience
- Must have three (3) years of coding experience in an acute care Level I trauma hospital environment.
- Physician office coding, charging and billing experience preferred
Equivalent Education and/or Experience
- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.
Certification/Registration/Licensure
- Must be certified through the American Health Information Management Association as one of the following: - Registered Health Information Management Technician (RHIT) - Registered Health Information Management Administrator (RHIA) - Certified Coding Specialist (CCS) - (Most desired of the certifications)
