Riverside HealthCare Hospital Coding Specialist III in Kankakee, Illinois
The Hospital Coding Specialist III accurately codes and abstracts all levels of inpatient medical records to achieve complete and compliant coding of assigned accounts and meet reimbursement, indexing, statistical, and reporting requirements. Scrutinizes DRG assignment to optimize reimbursement for inpatient care. Collaborates with clinical documentation improvement specialists, physicians, and other clinicians to clarify medical record entries and improve documentation practices. Assists with end-of-month and error reconciliation processes, including retrospective verification of medical necessity. Must have the ability to work independently in a fast-paced environment with the skills to prioritize and shift focus as need arises. Must project a mature, customer-focused attitude and professional demeanor in all contacts.
PART III: POSITION RESPONSIBILITIES (ESSENTIAL FUNCTIONS)
Accurately assigns and sequences appropriate ICD-10-CM for all diagnoses, procedures, signs, symptoms, and conditions documented in the medical record.
Actively participates in continuing education opportunities to improve job performance and/or maintain credentialing.
Actively works with Clinical Documentation Improvement team to enhance concurrent query process and knowledge of ICD and DRG principles.
Adheres to recognized coding guidelines in all aspects of work.
Assists in end-of-reporting-period, backlog completion, medical necessity verification, and error reconciliation processes.
Collaborates with Patient Financial Services and source departments to achieve timely error-free coding and billing.
Completes or reassigns records within coding queues to reflect coding status of each account handled.
Enters abstracted data into Affinity system.
Enters correct present on admission status for each diagnosis code assigned.
Groups cases into correct classifications (e.g. MS-DRG, APR-DRG)
Links procedure codes assigned during the coding session to the correct operative episode and physician.
Prepares, submits, and follows up on physician queries to clarify documentation and optimize reimbursement.
Promptly refers appropriate accounts for second review and follows up of each
Reviews and responds to CCI (correct coding initiative) edits and HAC (hospital acquired condition), ROM (risk of mortality), and SOI (severity of illness) status indicators identified during the encoder session to achieve compliant coding and optimize appropriate reimbursement.
Verifies accuracy of essential downloaded information.
Verifies that all physicians involved in the patient's care are correctly recorded in the abstract.
Experience/Education Requirements:Minimum three (3) years current hospital inpatient coding experience in the acute care setting or a comprehensive ambulatory surgery centerExpertise in ICD-10-CM and CPT coding principles essential.Strong knowledge of inpatient classification systems applicable to daily work (e.g., MS-DRGs, APR-DRGs)Thorough knowledge of Official Coding GuidelinesSolid command of medical terminology, human anatomy/physiology, pathophysiology, and disease process.Typing skills of 30 wpm with Windows-based PC knowledge base.Polished communication and customer relations skills.Ability to read and write in English.Detail-oriented, committed to accuracy, ability to problem solve.
License or Certification Requirements:Coding credential required: registered health information administrator (RHIA), registered health information technician (RHIT), and/or Certified Coding Specialist (CCS)
CategoryOther Non-Clinical Professional