Senior Coder - Orthopedics

Essential Function

• Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS‑DRGs and APCs assignment and all required modifiers.
• Validates charges by comparing charges with health record documentation as necessary.
• Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.
• Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.
• Tracks issues (e.g., missing documentation, charges and physician queries) that require follow‑up to facilitate coding in a timely fashion.
• Consistently or exceeds coding quality and productivity standards established by the coding department.
• Adheres to LCMC confidentiality requirements as they relate to release of any individual or aggregate patient information.
• Maintains up‑to‑date knowledge of changes in coding and reimbursement guidelines and regulations.
• Performs other duties as assigned by leadership.
• Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, and other policies and procedures to ensure adherence in a manner that reflects honest, ethical and professional behavior.

• Completion of an American Health Information Management Association (AHIMA) approved coding program or
• an American Academy of Professional Coders (AAPC) approved coding program or
• Associate degree in health information management or related field or
• an equivalent combination of years of education and experience required.

Minimum required:
Two (2) years of current complex outpatient and inpatient coding.

• Certified Coding Associate (CCA) from American Health Information Management Association (AHIMA) or
• Certified Inpatient Coder (CIC) and Certified Outpatient Coder (COC) combination from the American Academy of Professional Coders (AAPC).
• Internal staff who are not certified must obtain medical coding certification within twelve months through an approved LCMC coding program.

• RHIA/RHIT, Certified Coding Specialist (CCS) certification.

• Comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding, and MS‑DRG or APC grouping and components of charge description master for charging functions.
• Must possess knowledge of third‑party reimbursement regulations and billing practices.
• Experience utilizing encoding/grouping software.
• Ability to use standard desktop and Windows‑based computer systems, including basic understanding of email, internet and computer navigation.
• High ethical standards.
• Knowledge of ICD‑10‑CM, ICD‑10‑PCS, CPT/HCPCS, MS‑DRG, APR‑DRG and APC coding principles and guidelines.
• Experience in ICD‑10‑CM/PCS coding and reimbursement training.
• Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider‑based clinic encounters.
• Knowledge of hospital and professional coding including provider‑based billing.
• Knowledge of documentation regulations of Joint Commission and CMS.
• Experience with concurrent coding reviews.
• Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
• Experience in assisting and identifying learning needs as well as providing training to coding staff.
• Strong analytical abilities and problem‑solving skills.
• Excellent oral, written and interpersonal communication skills.
• Ability to organize and set priorities to ensure objectives are met in a timely manner.
• Ability to adapt to change and handle challenges proactively.
• Ability to effectively collaborate with physicians and managerial staff at all levels.

Variable Hours (United States of America)

Mid‑Senior level

Full‑time

Engineering and Information Technology

Hospitals and Health Care

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