Overview

Thoroughly reviews patient medical records as required to specifically and accurately code diagnoses and procedures treated or otherwise impacting the patient care. Effectively verifies the electronic medical record contains supporting documentation to justify diagnostic and procedural code assignments and follows up accordingly if questionable. Assists with auditing medical records for quality of coding and to ensure appropriate reimbursement, and reports findings to the Coding Program Manager. Also serves as backup for coding, billing, abstracting, and/or auditing of Outpatient and ED records. The Clinical Coding Specialist III is responsible for remaining current on all ICD and CPT coding changes as well as payer specific requirements and regulations.

Responsibilities

Coding of complex inpatient records.

Successful demonstration onf proficency and compliance with regulatory requirements

Identification of principal diagnosis and appropriate MS-DRG.

Complete coding of the record including appropriate coding of secondary diagnoses and inpatient procedures using ICD-10-PCS

Ability to write compliant coding queries.

Qualifications

Education/formal training/licensure/certification/experience:

· Degree in HIM. RHIA or RHIT preferred; CCS required.

· 4 years coding experience in hospital setting (at least 2 years inpatient)

· Experience in DRG validation or chart auditing preferred

· Thorough understanding and experience in both ICD-10 and CPT 4 required

· Minimum of 90% score on competency assessment

· Must be consistently exceeding standards of Level II and/or score minimum of 90% on competency sampling

Knowledge, skills and abilities required:

· Knowledge of DNV, Joint Commission and other regulatory agency chart documentation requirements

· Ability to work independently and function as an integral team member within the department.

· Strong analytical skills, detail oriented, and able to make decisions independently with consideration of the potential impact to reimbursement as well as external audit

· Must be able to work unsupervised and be self motivated with a strong understanding of prospective payments systems and coding guidelines

· Ability to perform work under pressure with ongoing deadlines and production/accuracy standards

· Use of computerized encoder and computer experience in Windows environment

Working Conditions

· Primary office setting, independent work environment

· Minimal conversation in office to facilitate level of concentration required

Physical Requirements

· Ability to tolerate long periods of sitting

· Numerical perception/visual acuity

· Excellent written and oral communication skills

· Motor coordination for operating computer