Clinical Coding Specialist III-- Full Time, Variable

Codes all diagnoses, treatments, and procedures according to the appropriate classification system for that category of patient encounter, and in accordance with provisions of the Uniform Hospital Discharge Data Set as well as the interpretation of these provisions as issued by the American Hospital Association and American Health Information Management Association and all governmental and private Third Party rules and regulations

Performs medical record abstracting of hospital admissions for reimbursement and statistical reporting

Concurrently codes LTAC, Rehab and acute care inpatients based on prescribed requirements by payer, using a computerized encoder and DRG grouper

Explains to and communicates with physicians regarding the changing of principal diagnoses on the attestation statement, based on lab and other diagnostic findings, when the record may be subjected to PRO review due to vague attestation/documentation

Assesses the adequacy of documentation to ensure that it supports the principal diagnosis, principal procedure and complications and comorbid conditions that are coded

Works with Clinical Documentation Specialists and Reimbursement Specialists to identify areas for improvement in physician documentation

Assesses OCE, NCCI and CCI edits as necessary to apply appropriate modifiers and make appropriate referrals to revenue departments, claim billers, senior coders and other hospital contacts as needed for accurate claim submission

Analyzes clinical findings to determine appropriate secondary diagnoses for patient severity indices

Uses independent judgment as to prioritizing charts for retrospective coding based on management of the unbilled accounts report

Uses good judgment in determining when to delay billing for obtaining additional documentation to support the assignment of a more optimal DRG

Makes coding supervisor aware of problem issues, negative physician communication and/or other influences that impact effectiveness of job performance

Other duties as assigned

Bachelor's Degree in Health Information Management or equivalent training and experience

RHIA, RHIT, CCS or other equivalent credentials required

5+ years coding experience required, preferably in a hospital setting

2 years inpatient coding preferred

Experience in a Health Information Management in an acute care facility, or with a Peer Review Organization, in Quality Assurance, or Utilization Review preferred

Medical terminology, anatomy and physiology, familiarity with medical record content and an understanding of the Uniform Hospital Discharge Data Set (UHDDS) definitions

Knowledge of ICD-CM coding principles under Prospective Payment System

Excellent communication skills required

Understanding that decisions are made with very serious impact affecting hospital reimbursement and PRO review determinations

High degree of interpretation, analysis, planning, coordination, and organization of information

Decisions require intense mental effort and consideration of reimbursement ramifications

Ability to utilize past experience, practices and organization to accomplish goals

Assigns accurate codes using good judgment in a timely manner within broad guidelines

Must be flexible and able to concentrate in a busy, noisy, and crowded environment with demands and interruptions 75% of the time

Near visual acuity required

Motor coordination required to operate computer

Work requires commuting between nursing units and Medical Record Department