Massachusetts Jobs

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Job Type:

Per Diem

Scheduled Hours:

0

Work Shift:

Day (United States of America)

Under the direction of the Hospital Coding Manager or Supervisor, and exercising independent judgment within the scope of the job, the Hospital Inpatient Coder II assigns applicable ICD-10 Codes, Present on Admission (POA), Hospital Acquired Condition (HAC), and Patient Safety Indicators (PSI) using current industry standards, the Official Coding Guidelines, Coding Clinic, UHDDS and regulatory requirements.

Ensures the integrity and quality of patient data to achieve minimal variation in coding practices; assigns codes only as supported by physician/licensed independent practitioner (LIP) documentation within the body of the medical record. Applies in-depth knowledge of medical terminology and anatomy and physiology specific to coding.

Job Description:

Essential Duties & Responsibilities including but not limited to:

1. Reviews and abstracts diagnoses and procedures from physician and other providers medical record information including but not limited to, history and physical, discharge summary, progress notes, orders, operative notes/reports, pathology reports, nursing notes, and medications.

2. Selects and sequences principal, secondary, and procedure based on provider medical record information to ensure accurate DRG assignment and reimbursement.

3. Assigns applicable ICD-10 Codes, Present on Admission (POA), Hospital Acquired Condition (HAC), and Patient Safety Indicators (PSI) codes using current industry guidelines from (but not limited to), AHIMA, Coding Clinic, CMS, specific payers, Agency for Healthcare Quality and Research (AHRQ) and CDC (official coding guidelines).

4. Utilizes grouper software to assist with assignment of accurate codes and to calculate appropriate DRG for hospital reimbursement.

Applies a thorough knowledge of medical terminology, anatomy & physiology and coding systems to accurately assign diagnoses and procedures in accordance with department, hospital, and regulatory requirements.

5. Submits queries to providers as needed when a diagnosis or procedure has been determined to meet the guidelines for reporting but has not been clearly or completely stated within the medical record, when ambiguous or conflicting documentation is present, or when documentation is unclear for POA indicator assignment.

6. Acts as a resource to representatives from Patient Financial Services as needed to provide accurate coding/billing data and expedite the billing process.

7. Demonstrates efficiency in use of hospital information system by abstracting all information, codes and charges appropriately, including 3M, Epic, and Cobius.

8. Communicate issues with incorrect documentation and software inability to complete functions to Manager or Supervisor of Hospital Coding as needed.

9. Reviews denials in Cobius Denial Software and determine appropriate resolution based on audit.

10. Works with Clinical Decision Specialists regarding MD Queries and correlation of care.

11. Receives accounts from DRG Validator and adjusts accordingly for optimization of account

Additional Level II Responsibilities

1. Codes high dollars and long lengths of stay.

2. Mentors New Coding staff and provides continuous communication and instruction with colleagues.

Minimum Qualifications:

Education:

• Minimum High School degree or equivalent; college degree highly desirable.

Licensure, Certification & Registration:

• CCS, CCS-P, CPC, CPC-H

Experience:

• Minimum five years of hospital inpatient coding experience and/or an RN or other healthcare clinician with at least 5 years acute care experience (e.g., medical-surgical, ICU, case management, etc.).

Skills, Knowledge & Abilities:

• Knowledge of Medical Terminology, Anatomy & Physiology, and coding clinical concepts such as gained from coding coursework.

• Knowledge of payment methodologies including prospective payment (PPS), federal and state regulations.

• Computer skills, including knowledge of Microsoft Office and encoder.

• Ability to work in a high paced, high volume, multi-task environment.

• Strong organization and communication skills.

FLSA Status:

Non-Exempt

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) and COVID-19 as a condition of employment. Learn more (https://www.bilh.org/newsroom/bilh-to-require-covid-19-influenza-vaccines-for-all-clinicians-staff-by-oct-31) about this requirement.

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Equal Opportunity Employer/Veterans/Disabled