Coding Specialist III

Primary Purpose

The primary purpose of the Coding Specialist III is to code and verify data necessary to ensure correct coding, abstracting, and billing on inpatient (IP) encounters. This position requires the coder to be highly proficient in the proper assignment of ICD‑10 CM, PCS, CPT, HCPCS, HCC, HEDIS CAT II and modifier codes for both professional and hospital charging, coding and billing. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland’s policies to ensure accuracy of recorded patient medical information and appropriate reimbursement for services rendered.

• Education: High school diploma required. Must have successfully completed an approved coding program or be a graduate of a health information management program.
• Experience: Three (3) years of coding experience in an acute care Level I trauma hospital environment. Physician‑office coding, charging and billing experience preferred.
• Certification/Registration/Licensure: Must be certified through the American Health Information Management Association as RHIT, RHIA, CCS or a comparable credential.
• Skills or Special Abilities: Advanced knowledge of ICD‑9/ICD‑10‑CM/PCS coding and abstracting, MS‑DRG classification and reimbursement structures, applicable coding edits and local coverage. Proficient in CPT, HCPCS, HCC, HEDIS CAT II and modifier code assignment. Must score at least 85% on the pre‑employment coding test (contract coders with a proven 95% accuracy rate are exempt). Demonstrated knowledge of Medicare and Medicaid reimbursement principles, advanced medical terminology, anatomy and physiology, as well as strong organizational, leadership, and communication skills.
  
  Familiarity with MS Office, Computer Aided Coding (CAC), Epic EHR and 3M 360 coding software is preferred.

• Assign principal and secondary diagnosis and procedure codes for all inpatient encounters, ensuring accurate DRG assignment in line with ICD‑10‑CM/PCS conventions, guidelines and hospital policy.
• Achieve and maintain 95% accuracy on quality reviews while meeting assigned productivity standards.
• Abstract statistical data from the medical record and enter information in accordance with Parkland’s guidelines, policies and procedures.
• Verify, edit and/or enter charges based on documentation or insurance requirements, reporting any discrepancies promptly.
• Coach and train other coders, respond to coding inquiries, review coded charts, provide feedback, and monitor chart corrections to maintain coding consistency, accuracy, and appropriate billing.
• Contribute to workflow and prioritization of work, communicate workflow issues to supervisors, and identify improvements to increase customer satisfaction. Implement and monitor recommended changes.
• Collaborate with physicians and nurses to clarify or complete records, obtain missing diagnoses or procedures, and resolve ambiguous coding episodes for accurate payment.
• Build and maintain positive relationships with management, coders, physicians, nurses, medical staff, COPCs, Financial Control, Business Services and hospital employees, ensuring that medical record information is documented and coded per convention and policy.
• Stay current on rules, regulations, policies, laws and guidelines affecting coding and abstracting, developing internal controls that promote compliance.
• Audit error reports, maintain departmental quality standards, and submit productivity logs to supervisors.
• Continuously update knowledge of coding developments through workshops, journals, professional organizations, and apply new insights to practice.
• Maintain continuing education hours and renew annual coding credentials.
• Perform routine screening and proof of immunizations exclusions for virtual workforce employees as specified by Parkland’s Virtual Work procedure.