Hospital Coding Specialist

Conducts thorough review of medical record documentation and assigns codes for diagnoses and procedures utilizing the ICD-10 CM, ICD-10 PCS, CPT and HCPCS coding classification systems. Abstracts required data elements needed for reimbursement and reporting purposes. Follows workflows related to severity of illness, risk of mortality, hospital acquired conditions, patient safety indicators and mortality reviews so the appropriate reimbursement is obtained and the complexity of care for treatment and services provided is reflected. Work claim edits and review denials, as directed by supervisor. Collaborates with providers, CDI, IS, Patient Financial Services, Quality Management and Case Management. Performs other duties as assigned.

Essential Duties and Responsibilities

• Review medical record documentation and, in accordance with all applicable coding guidelines, assign ICD-10 CM, ICD-10 PCS, CPT and HCPC's diagnosis and procedure codes. Enter modifiers, POA indicators, anesthesia information and other required abstracting elements, as appropriate for the type of record being coded.
• Utilize computer assisted coding technology, encoder and grouper to code and complete accounts. Review and validate all codes on the code summary list.
• Code high dollar records first, and then code the oldest in order by dollar amount. IP: > $60,000; OPS/OBSV: > $15,000; ED/Ancillary: > $4,000
• Work and resolve Optum and Epic edits and coding validation checks at the time of coding, preventing claim edits and denials.
• Query providers to ensure documentation supports appropriate code assignment, reimbursement, present on admission and quality measures (i.e. SOI, ROM, HAC's, PSI's, etc.).
• Work with CDI Specialists and review CDI notes to reconcile all DRG's and ensure that all quality related workflows, such as mortality, HAC and PSI reviews, are followed.
• Cross-train in coding and abstracting functions, as appropriate, for all record types and associated functions.
• Validate ED/UC Physician CPT- E/M procedure code assignments. Verify and/or enter specific charges and billing information (e.g. Rev codes, OBSV charges), as required.
• Focus on one or more of the following areas:
• Code and abstract one or more OP coding types: ED, UC, observation, outpatient surgery and/or ancillary/recurring patient classes.
• Code and abstract IP accounts of lower complexity and shorter lengths of stay.

Education and Experience

Bachelor's degree in Health Information Management, Associate's degree in Health Information Technology or graduate of a Medical Coding Specialist program preferred.
One year of hospital inpatient, outpatient, ED, and/or professional fee coding experience required.

Certification and Licensure

RHIA, RHIT, CCS, CCS-P, CPC-H, CPC, COC, CEDC, graduate of a Medical Coding Specialist program, or other applicable coding certification, required.

Skills and Abilities
Excellent customer service, critical thinking and verbal and written communication skills needed.

Computer Skills
Strong computer skills needed. Knowledge and experience with the Optum CAC and encoder, Epic, Excel, Microsoft Outlook and Microsoft Word preferred

The Special Physical Demands are considered Essential Job Functions of the position with or without reasonable accommodations.
While performing the duties of this job, the employee is regularly required to sit and use hands to reach, finger, handle, or feel. The employee must occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close vision.

To perform the job successfully, an individual should demonstrate the following behavior expectations:

Quality - Follows policies and procedures; adapts to and manages changes in the environment; Demonstrates accuracy and thoroughness giving attention to details; Looks for ways to improve and promote quality; Applies feedback to improve performance; Manages time and prioritizes effectively to achieve organizational goals.

Service - Responds promptly to requests for service and assistance; Follows the Mercyhealth Critical Moments of service; Meets commitments; Abides by MH confidentiality and security agreement; Shows respect and sensitivity for cultural differences; and effectively communicates information to partners; Thinks system wide regarding processes and functions.

Partnering - Shows commitment to the Mission of Mercyhealth and Culture of Excellence through all words and actions; Exhibits objectivity and openness to other's views; Demonstrates a high level of participation and engagement in day-to-day work; Gives and welcomes feedback; Generates suggestions for improving work: Embraces teamwork, supports and encourages positive change while giving value to individuals.

Cost - Conserves organization resources; Understands fiscal responsibility; Works within approved budget; Develops and implements cost saving measures; contributes to profits and revenue.