Senior Clinical Coding Specialist - OR Surgery

SUMMARY

The primary purpose of the Senior Clinical Coding Specialist position is to analyze medical records and abstract clinical data by assigning codes from patient records in accordance to coding classification systems. Reviews patient encounters for accurate code assignment of all relevant diagnosis and applicable modifiers. Enters appropriate codes into the 3M encoder hospital's mainframe computer for the transfer of data to billing files for reimbursement.

Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous or unclear for coding purposes. Serves as a resource for other departments users related to the abstracted coded data.

• Effectively communicate and interact with members of the combined coding team, management, peers, business office, and external customers
• Provides detailed questions and supportive feedback to management and coordinators when inquiring for assistance with coding questions, quality reviews, and coding education/training.
• Capable of providing supportive feedback to management and coordinators for internal and external requests on coding corrections/edits or re‑reviews.
• Promptly report workflow or system issues to management

• Advance professional growth and development through continuing education, pertinent literature, coding rounds, seminars, and other educational forums.
• Participates and provides ongoing feedback, when necessary, on documentation challenges, potential coding compliance concerns, and opportunities for coding clinic updates.
• Actively participates in ongoing team and departmental staff meetings.

• Instrumental in maintaining discharged not final billed (DNB) and placeholder or Pre‑AR accounts thresholds baselines per the direction of coding leadership
• Ability to comprehend and appropriately apply official coding guidelines, coding clinics, utilizing departmental coding policies, and Craneware. Knowledgeable in identifying. Initiate queries when appropriate
• Review medical record documentation, understand, and assign accurate primary, ICD‑10 CM, CPT/HCPCS, modifiers, LCD/NCD, MUE, and NCCI methodologies codes to professional records when utilizing 3M software, EPIC, or coding books.
• Complies with the Standards of Ethical Coding set forth by the American Health Information Management Association (AHIMA) and adheres to the official coding conventions and guidelines, and upholds HIPAA compliance rules and regulations.

Reports to:
Manager, Clinical Coding Operations

• Required:
  
  Associate's Degree Health Information Management, Healthcare Administration, or related healthcare field.
• Preferred:
  Bachelor's Degree Health Information Management, Healthcare Administration, or related healthcare field.

• Required:
  
  5 years Clinical coding experience for complex or multi‑specialties. or
• Required:
  
  3 years Clinical coding experience for complex or multi‑specialties with preferred degree.
• May substitute required education degree with additional years of equivalent experience on a one to one basis.

• Prior experience working in a Teaching Hospital setting. This specific position is for a surgical position in OR surgical coding for both the physician and the facility.
• Experience in Breast and Plastics, Surgical Oncology, Head and Neck, and/or Urology.
• A strong foundation in medical coding principles, including knowledge of ICD‑10, CPT and HCPCS, along with practical experience in both inpatient and outpatient coding.

• RHIA - Registered Health Information Administrator American Health Information Management Association (AHIMA).
• RHIT - Registered Health Information Technician American Health Information Management Association (AHIMA).
• CCS-Certified Coding Specialist American Health Information Management Association (AHIMA).
• CCA - Certified Coding Associate American Health Information Management Association (AHIMA).
• Certified Coder-AHIMA or AAPC American Academy of Professional Coders (AAPC).
• CPC-A - Cert Prof Coder-Apprentice…