Hospital Coding Specialist III

• Strongly knowledgeable of the ICD-10 Official Guidelines for Coding and Reporting provided by the Centers for Medicare and Medicaid Services (CMS) and the National Center for Health Statistics (NCHS) and the American Medical Association (AMA) CPT Coding Guidelines. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association.
• Reviews electronic medical records and identifies all treated diagnoses and significant procedures performed.
• Uses coding software to assign ICD-10-CM diagnosis and ICD-10-PCS procedure codes, Present on Admission Indicators, and CPT codes and modifiers when indicated, to ensure coding accuracy, DRG optimization and APC accuracy.
• Sequences diagnosis codes according to the definition of principal diagnosis and other co-morbid conditions and complications. Sequences procedure codes according to the definition of principal procedure and other procedures.
• Utilizes online coding references, CMS Local Coverage Determinations (LCDs), and other payor guidelines to ensure appropriate code assignment for Compliance, Billing, and Medical Necessity.
• Ensures all diagnosis and procedure codes, present on admission indicators, modifiers, procedure dates, and surgeons are accurately transferred from the coding software to the coding and billing application.
• Identifies and communicates documentation opportunities relative to appropriate coding assignment. Completes physician queries as indicated for clarification of documentation.
• Makes data entry in the coding software for Clinical Documentation Improvement (CDI) reviews to effectively communicate with CDI Specialists regarding differences in DRG assignment, Mortality reviews and Quality reviews including Patient Safety Indicators (PSI's) and Hospital Acquired Conditions (HAC's).
• Utilizes abstracting application to enter and /or update Consulting Physicians, Discharge Dispositions, and Attending Physician.
• Reviews and responds to internal and external coding audits in a timely manner.
• Reviews and resolves coding and reimbursement related denials and edits to ensure timely submission of claims.
• Remains informed of continual changes in coding and billing and maintains compliance with federal, state and hospital policies.
• Completes all assigned online training and education activities timely and attends all required onsite meetings.
• Responds to e-mails and requests from Supervisor, Manager and other hospital employees in a professional and timely manner.
• Consistently meets required productivity and accuracy standards.
• Responsible for maintaining coding certification.
• Performs related responsibilities as required or directed.

EDUCATION:

• Skill and proficiency in diagnosis and procedure coding, and other principles, concepts and techniques of Health Information Management. Such proficiency is acquired through a RHIA, RHIT, or CCS certification or a Health Information program accredited by AHIMA.  

LICENSURE, REGISTRATION, CERTIFICATION:

• Registration and/or certification as RHIA, RHIT, or CCS by AHIMA  

EXPERIENCE:

• Knowledge of Health Information Management practices, coding and coding guidelines, as acquired through a RHIA, RHIT, or CCS credential. Meets all experience requirements for Coding Specialist I and II and ability to code a minimum of 15-20 hospital inpatient records per day.