Criteria Based Job Description Job Title: Health Information Coding Analyst II  Reports to: HIM Coding Manager Job Code: 2003395 Approved by: HIM Senior Coding Manager Department: Health Information Management Approval Date: 09/2020, 03/2022, 11/2023

 

MINIMUM QUALIFICATIONS:

Education:

Graduate from an associate or bachelor degree program in health information, completion of a coding specialist program or successful completion of AHIMA or AAPC coding credential exam.

 

Experience: 3-5 years’ experience in ICD-10/CPT coding Licensure/ Registration/ Certification:

CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS (Homecare Coding Specialist), CEDC (Certified Emergency Department Coder), CCS-P (Certified Coding Specialist-Physician based), RHIT (registered health information technician), or RHIA (registered health information administrator)

Knowledge, Skills and Abilities:

Knowledge in using CPT-4, ICD-10 CM/PCS coding guidelines, rules and regulations

Knowledge of anatomy and physiology

Knowledge of basic disease processes

Knowledge of medical terminology

Intermediate computer skills required

Ability to communicate information in a professional, confident, and confidential manner.

 

PREFERRED QUALIFICATIONS:

Education:

Graduate from an associate or bachelor degree program in health information or completion of a coding specialist program.

 

Experience: 5+ years’ experience in ICD-10/CPT coding Licensure/ Registration/ Certification:

CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS (Homecare Coding Specialist), CEDC (Certified Emergency Department Coder), CCS-P (Certified Coding Specialist-Physician), RHIT (registered health information technician), or RHIA (registered health information administrator)

 

Knowledge, Skills and Abilities:

Demonstrates a thorough understanding of the front and back-end revenue cycle components in a physician and hospital setting.

 

POSITION SUMMARY STATEMENT:

As a coding analyst, you will support multiple sites and actively participate within a team who performs a wide variety of complex coding scenarios to ensure accurate assignment of ICD-10 and CPT Codes. This position completes coding analysis of each individual patient stay. It provides accurate diagnoses, procedures and other relevant data base information for optimal financial reimbursement, collection of unique and pertinent information and accumulation of statistical data; and perform related duties as assigned. Some components of the major job duties and tasks may not pertain to your position, some are inpatient coding specific, and some are outpatient coding specific. If you have questions on what pertains to your position, contact your leader. 

 

 

MAJOR JOB DUTIES AND TASKS:

Percentage

Of Time:

  1. Health information documentation 70%
  Select the diagnoses and procedures that require coding according to current coding and reporting requirements for acute care services for inpatient and outpatient

Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures; writing and sending queries as necessary.

Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems or other reasons for the encounter that require coding.

Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding.

Sequence diagnoses, reasons for encounter, and procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as Uniform Hospital Discharge Data Set (UHDDS)

Utilizes technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10-CM diagnosis and procedures for inpatient encounters Assigns present on admission (POA) value for inpatient diagnoses

Extracts required information from source documentation and enters into encoder abstracting system

Identifies non-payment conditions (HAC) and when required, report through established procedures

Reviews documentation to verify and, when necessary, correct the patient disposition upon discharge

Apply the official ICD-10-CM/PCS coding guidelines.

Apply the official CPT/HCPCS Level II coding guidelines.

Adheres to all compliance guidelines, both internal and external

Demonstrates ability to meet or exceed departmental quality and productivity standards.

Works closely with clinical documentation improvement specialist and assists them with understanding coding principals and rules as applicable. 

Participates in continuing education programs to maintain an understanding of anatomy physiology, medical terminology, disease processes to support the effective application of coding guidelines. 

Enhances professional growth and development through participation in professional organizations, coding round tables, literature reviews, and relevant workshops.

m) Assists in training of new employees 

n) Attend coding department meetings as scheduled. 

o) Performs other duties as assigned

 

 

2. Regulatory guidelines and reporting requirements for acute care (inpatient) service 5%
  Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to the UHDDS definitions and coding clinic for ICD-10-CM and ICD-10-PCS
  Evaluate the impact of code selection on diagnosis related group (DRG) assignment
  Verify DRG assignment based on inpatient prospective payment system (IPPS) definitions
  Assign the appropriate admission source and discharge disposition
  Works with Team Leads to resolve coding denials

 

3. Regulatory guidelines and reporting requirements for outpatient services 5%
  Select the reasons for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT assistant, coding clinics for ICD-10-CM, ICD-10-PCS and HCPCS. This is accomplished through 100% chart abstraction.
  Apply outpatient prospective payment system (OPPS) reporting requirements:
 

Modifiers

CPT/HCPCS Level II

Medical necessity

Review nurse and provider documentation for facility leveling, procedure, IV & Infusion, ICD 10 codes for Emergency Room Facility charges. This is accomplished through 100% chart abstraction.

Review and abstract provider documentation for Staff MD alone, Teaching and Shared services. Abstract provider E&M levels, procedure and ICD 10 codes. This is accomplished through 100% chart abstraction

Works with Team leads to resolve claim edits and coding denials

 

4. Data quality and management 5%
 
  Assess the quality of coded data
 
  Educate health care providers regarding reimbursement methodologies, documentation rules and regulations related to coding
 
  Analyze health record documentation for quality and completeness of coding
 
 

Review the accuracy of abstracted data elements for data base integrity

Review and resolve coding edits (such as correct coding initiatives (CCI), Medicare code editor (MCE) and outpatient code editor (OCE).

 
 

 

  5. Information and communication technologies 5%
 
 

Use common software applications (e.g. word processing, spreadsheets, email, etc) in the execution of work processes

Use specialized software in the completion of the coding processes

 
 
  6. Privacy, confidentiality, legal and ethical issues 5%
 
 

Apply policies and procedures for access and disclosure of personal health information

Apply AHIMA Code of Ethics/Standards of Ethical Coding

Recognize/report privacy issues/problems

Protect data integrity and validity using software or hardware technology

 
 
  7. Compliance 5%
 
 

Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards

Recognize/report compliance concerns/findings

 

 
 

Job/Performance Expectations:

Maintain 95% or greater coding accuracy rate.

Meet departmental productivity standards.

Protects confidentiality

Ability to work remote in a private setting

Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

 

 

ORGANIZATIONAL EXPECTATIONS:

 

Values

All team members are expected to demonstrate our values:  

Excellence:  We strive for the best results and always look for ways to improve.

Compassion:  We care and show empathy and respect for each person.

Partnership:  We are strongest when we work together and with those we serve.

Integrity:  We are open and honest, and we keep our commitments.

We are committed to living our values. That means our patients and families can expect certain things from each of us:

They can expect us to be their partner and treat them with dignity and respect. They can expect us to listen carefully and give good, timely information. They can expect us to do our best to provide affordable, coordinated, high quality care and services that are easy to find and simple to use. They can expect safe, clean spaces. And they can expect that we will do our very best to earn their trust by being open and honest, and keeping our word.

 

Additional Expectations:

Complies with safety instructions, observe safe work practices, provides input on safety issues and promotes a safe work environment. 

Maintains regular and timely attendance 

Protects confidentiality

Demonstrates participation in and support of the organization's Corporate Integrity Program by participating in compliance-related education and training and complying with the organization's policies and procedures.  

Timely completion of all mandatory education and organizational requirements (i.e. licensure/certification, Employee Health and Wellness requirements, annual training, etc.)

 

POPULATION SPECIFIC COMPETENCIES:

 

Yes

 

 

X No

 

 

Does this employee have direct patient contact? 

LEADERSHIP RESPONSIBILITIES:

None

 

PHYSICAL REQUIREMENTS:

Requires sitting at desk, using a computer for prolonged periods. May involve standing, stooping, or bending, and lifting up to 25 pounds. Uses arms, wrists, hands and fingers daily while using the computer for data entry or retrieval.

 

ENVIRONMENTAL CONDITIONS:

This is a telecommuting role. There are no unusual or extreme conditions. Work is 100% indoors. 

 

EQUIPMENT:

Computer, web-camera, and headset