HIM CODING SPECIALIST II

HIM Coding Specialist II - Full Time

Shift: Days, 8:00a - 4:30p

Job Description:

PATIENT POPULATION:
The patient population served can be all patients, including geriatric, adult, adolescent, pediatric, and newborn. This also includes services which affect facility staff, physicians, visitors, vendors and the general public.

POSITION SUMMARY:
Under the supervision of the Director of Health Information Management (HIM), the HIM Coding Specialist II-CCS, CPC, CPC-H, CCS-P (or equivalent) performs complex duties to review, abstract, code and conduct risk surveillance on both Inpatient and Outpatient medical records for statistical, administrative, billing and risk surveillance purposes.

Must be able to work normal/scheduled working hours to include Holidays, call-backs, weeknights, weekends, and on-call. Agrees to participate, as directed, in emergencies and community disasters during scheduled and unscheduled hours. As a designated disaster service worker you are required to assist in times of need pursuant to the California Emergency Services Act.
(Gov't. Code §§ 3100, 3102)

Needs to recognize that they have an affirmative duty and responsibility for reporting perceived misconduct, including actual or potential violations of laws, regulations, policies, procedures, or this organization's standards/code of conduct.

The employee shall work well under pressure, meet multiple and sometimes competing deadlines; and the incumbent shall at all times demonstrate cooperative behavior with colleagues and supervisors.

EDUCATION/TRAINING/EXPERIENCE:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

To perform this job successfully, an individual should be a high school graduate or equivalent. Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) and/or CCS-P) or Certified Professional Coder (CPC), or equivalent approved certification, with a minimum of 2 years coding experience in an acute care facility using ICD-9-CM and CPT/DRG assignment. Knowledge of ICD-10-CM coding principles for both acute care and skilled nursing facilities. Knowledge of the prospective payment system and impact of codes upon reimbursement required. Knowledge and experience in medical terminology, anatomy, and physiology.

Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence if required. Ability to work with physicians in a collaborative manner.

Ability to calculate figures and amounts such as discounts, interest, commissions, proportions, and percentages if required.

Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations. Effective time management skills to permit working in a fast-paced, results-oriented environment. Detail oriented.

To perform this job successfully, an individual should have demonstrated data entry skills. Type 40-50 wpm. Computer terminal experience and basic working knowledge of commonly used business software (including but not limited to Microsoft Office, Word, Excel and e-mail).

LICENSURE/CERTIFICATIONS:
To perform this job successfully, an individual should be a high school graduate or equivalent. Registered Health Information Technician (RHIT) or Certified Coding Specialist (CCS) and/or CCS-P) or Certified Professional Coder (CPC), or equivalent approved certification, with a minimum of two (2) years coding experience strongly preferred in an acute care facility using ICD-9-CM and CPT/DRG assignment.

Responsibilities and Essential Functions:
*Indicates Essential Function

1 * Analyzes and interprets patient medical records to identify and determine amount and nature of billable services; assigns and sequences appropriate diagnostic/procedure billing code in compliance with requirements of government (Medicare/Medi-Cal/VA/Tricare) services as well as third party payer requirements.
2 * Performs data entry into on-line medical record abstracts and verifies the accuracy of the data imported back from the 3M encoder system.
3 * Determines the appropriate onset of diagnosis Present on Admission (POA) indicator for each diagnosis to identify adverse outcomes. Collects additional data on risk events as required. Identifies and reports sentinel events for Risk Surveillance as directed.
4 * Monitors billing performances to ensure optimal reimbursement while adhering to regulations prohibiting unbundling and other non-compliant practices; prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
5 * Stays current with all coding related regulations and reimbursement activities to optimize our revenue cycle management from a coding perspective.
6 * Assures timeliness of the coding process by maintaining a running list of accounts not coded and rechecking for codability.
7 * Meets quality standards of having 95.5% of principal diagnoses and procedures appropriately and correctly coded.
8 * Maintains a 95.5% monthly productivity rate.

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