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Senior Coding Specialist

2 months ago

Valhalla, United States NorthEast Provider Solutions Inc. Full time

Job Summary:

The Senior Coding Specialist is responsible for addressing appeals to insurance companies and coding highly complex medical records, including all diagnoses and operative and diagnostic procedures in patient medical records, using the current International Classification of Diseases (ICD), Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedures Coding System (HCPCS), and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected. Does related work as required.

Responsibilities:

  • Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
  • Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures.
  • Identifies and analyzes patterns in possible coding errors or other trends and reports to the Supervising Medical Records Coder.
  • Participates in mandated medical record review processes.
  • Using current HCPCS, ICD, and CPT coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
  • Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly.
  • Makes appropriate contacts in order to acquire or clarify necessary information.
  • Enters final diagnostic code numbers and narrative descriptions of diagnoses and procedures into an automated grouper system.
  • Compiles and updates the appeal log detailing denials, hospital's reply and follow-up responses.
  • Provides information and responds to inquiries regarding medical documentation and DRG'S to hospital staff including utilization and quality assurance staff, patient accounts staff and the Risk Manager.
  • Abstracts information from medical records to compile reports and statistical information.
  • Enters data such as diagnosis, treatment, admission and discharge dates, and length of stay on hospital-wide or regional automated database.
  • May train lower level coders and provide technical guidance and expertise.

Qualifications/Requirements:

  • 6 years of experience where the primary function of the position must have been medical records coding, four of which must have been within the last five years, two of which must have involved coding emergency room or trauma cases.
  • High School or equivalency diploma, required. Satisfactory completion of 30 credits* toward an Associate's degree or Bachelor's degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience. There is no substitution for the two years of specialized experience.
  • Current certification as either a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician Based (CCS-P) through AHIMA, or as a Certified Professional Coder (CPC) through the American Academy of Professional Coders, required. Certification as Registered Health Information Administrator (RHIA) (formerly Registered Records Administrator (RRA)) or as a Registered Health Information Technologist (RHIT) (formerly Accredited Records Technician (ART)) by the American Health Information Management Association
  • Comprehensive knowledge of the American Hospital Association (AHA) Official Coding Guidelines; comprehensive knowledge of the current HCPCS, CPT and ICD codes; thorough knowledge of DRG and APC classification systems; thorough knowledge of medical terminology; thorough knowledge of the principles of the unit medical record system and its operation; ability to understand and code medical records; ability to communicate effectively both orally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; ability to read, write, speak, understand, and communicate in English sufficiently to perform the essential duties of the position; assertiveness; thoroughness; sound judgment; tact; discretion; initiative; accuracy; physical condition commensurate with the demands of the position.