Coder III

We are seeking a highly skilled and experienced Coder III to join our team at Huntsville Memorial Hospital. As a Clinical Data Quality Manager, you will play a critical role in ensuring the accuracy and consistency of inpatient and outpatient claims processing and data collection.

• Assist in coordinating activities of coding and clerical employees, analyzing, compiling, coding, filing, and data entry of medical records.
• Assign codes for diagnoses, treatments, and procedures according to the appropriate classification system for inpatient and outpatient encounters.
• Monitor records per doctor to ascertain status on completeness and take action as indicated by hospital policy.
• Assist in training and educating medical record employees on departmental functions, changes in coding procedure/process changes, confidentiality, and other departmental issues as needed.
• Extract required information from source documentation and enter into encoder and abstracting system.
• Perform data quality review on records to validate the ICD and CPT codes, DRG or APC group appropriateness, missed secondary diagnoses and procedures, and ensure compliance with all DRG mandates and reporting requirements.
• Evaluate the quality of clinical documentation to trend incomplete or inconsistent documentation for inpatient encounters that impact the code selection and resulting DRG groups and payment.
• Query physicians when code assignments are questionable or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Provide educational opportunities for facility healthcare professionals in use of coding guidelines and practices, proper documentation techniques, medical terminology, and disease processes, appropriate to the job description and function as it relates to the DRG and other clinical data quality management factors.
• Develop reports and collect and prepare data for studies involving inpatient stays for clinical evaluation purposes and financial impact and profitability as required.
• Perform concurrent review, DRG assignment of inpatients and attend weekly case management meeting, when needed.
• Attend coding and reimbursement workshops and bring back information to the appropriate departments. Communicate any coding updates published with coding staff and other relevant positions.
• Demonstrate competence in use of computer applications and DRG/APC Grouper software, Medicare edits, and all other coding and abstracting software and hardware currently in use in the department.
• Perform periodic claim form reviews to check code transfer accuracy from the abstracting system and the charge master or as requested from the billing office.
• Evaluate, record, and respond to the Peer Review Organization (PRO) DRG change and denial notices. Provide appropriate documentation from required source to the PRO when appealing a PRO decision.
• Monitor unbilled accounts report for outstanding or uncoded discharges to reduce accounts receivable days for inpatients.
• Abide by the HMH Legal Compliance Code of Conduct.
• Maintain a safe work environment and report safety concerns appropriately.
• Maintain patient confidentiality and appropriate handling of PHI.
• Perform all other related duties as required and assigned.