This position assigns, per coding guidelines, the current version of ICD diagnosis and procedure codes and CPT-4 procedure codes for Observation, Same Day Surgery, Emergency Department, Urgent Care and/or Ancillary medical records. Completes coding for all accounts on a timely basis within the four day bill hold time frame. Follows up on all accounts needing coding queries or documentation completion by clinicians or medical staff. Demonstrates coding competencies with quality of coding and daily output of volume consistent with department productivity standards.
Family-Centered care that focuses on the need of the child first and values the family as an important member of the care team
Excellence in clinical care, service and communication
Collaborative within our institution and with others who share our mission and goals
Leadership that set the standard for pediatric health care today and innovations of the future
Accountability to our patients, community and each other for providing the best in the most cost-effective way.
Maintains consistent coding accuracy rate of 95% or better.
Assigns diagnosis codes and procedure codes utilizing the current version of ICD and CPT-4 coding classification systems in compliance with hospital guidelines, the current version of ICD Official Guidelines for Coding and Reporting, and UHDDS definitions.
Meets the established productivity standards for each visit type coded.
Abstracts clinical and requested data from the health record and enters into HRM with a 99% abstraction accuracy rate.
Communicates with medical staff when appropriate to facilitate the assignment of proper diagnosis and procedure codes.
Demonstrates competencies with all software and hospital systems utilized, including HRM, ChartMaxx, SCM, 3M Encoder, MedAptus and AMPFM.
Monitors daily the Fatal Edit report to ensure all assigned records are coded on a timely basis within the four day bill hold time frame.
Acts as a resource to hospital staff for all coding related questions. Responds in a timely manner to e-mails, bill edits, or other requests.
Maintains professional certification and technical competency by attending education and training activities sponsored through the hospital, professional associations, and through independent study. Keeps apprised of current trends, developments and awareness of coding changes.
Performs miscellaneous job related duties as requested.
Associates degree in Health Information Management or equivalent combination of post-secondary education and experience. - Required
Requires minimum of 3 years coding experience or is proficient coding two or more of the following visit types (Observation, Same Day Surgery, Urgent Care, and Emergency Department). - Required
Experience with utilizing the 3M encoder software system and electronic abstracting system. - Preferred
Experience in assigning CPT Evaluation and Management codes for physician and facility services. - Preferred
Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist (CCS) certification by AHIMA, or Certified Professional Coder (CPC) certification by AAPC.