Inpatient Coder Specialist

Overview

This role encompasses all responsibilities of coder I, II, and III, with additional duties to review complex inpatient documentation at a highly skilled level to assign diagnosis and procedure codes using ICD-10 CM/PCS, CPT, and HCPCS. Codes are assigned and selected in compliance with Official Coding Guidelines and federal and insurance regulations, using an EMR and/or Computer Assisted Coding software.

• Adhere to organizational and internal department policies and procedures to ensure efficient work processes.
• Code high-dollar and long-length-of-stay cases for all patient types.
• Demonstrate expertise in query guidelines and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
• Serve as a subject matter expert to Coding department leaders and peers. Recommend modifications to current policies and procedures to align with government regulations.
• Maintain continuing education by attending webinars and reviewing updated CPT assistant guidelines and coding clinics. Research coding-related topics and issues.
• Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to Official Coding Guidelines. Exercise ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
• Collaborate with Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconcile Medicare cases with working DRGs from a CDI perspective.
• Communicate with clinicians regarding disease processes at a clinical level to ensure accurate coding.
• Participate in payer audits and meetings as a resource for coding-related audits, as requested.
• Attend meetings with clinical teams regarding updates in codes for complex specialties.
• Maintain patient-record confidentiality. Report any perceived non-compliant practices to the coding leader or compliance officer.
• Meet and exceed departmental quality (95% or more) and productivity standards (100%). Achieve productivity to support discharged not final billed (DNFB).
• Perform other assigned duties as needed; duties listed are examples and not exclusive. Management reserves the right to add or change duties at any time.

• Coding Certification from AAPC or AHIMA.

• Associate2s Degree in Health Information Management or a related field.

• Typically requires 7 years of inpatient coding experience in an acute care tertiary facility, including revenue cycle processes, Clinical Documentation Improvement, research, and health information workflows.

• Advanced proficiency in ICD, CPT, and HCPCS coding guidelines. Strong knowledge of medical terminology, anatomy, and physiology.
• Excellent computer skills, including Microsoft Office and email; experience with electronic coding systems or applications.
• Excellent communication (oral and written) and interpersonal skills.
• Excellent organization, prioritization, and reading comprehension skills.
• Strong analytical skills with high attention to detail.
• Ability to work independently and exercise independent judgment and decision-making.
• Ability to meet deadlines in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

• Normal office environment.
• Must be able to sit for extended periods.
• Must be able to concentrate continuously.
• May require travel to other sites and exposure to road and weather hazards.
• Operates all equipment necessary to perform the job.
• This description reflects the general nature and level of work expected; it is not exhaustive of all duties. Incumbent may be required to perform other related duties.

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