Medical coder job description

$5,000 dollar sign on bonus! Remote work for this position may be approved based on policy and business considerations.

Job Summary Assigns correct procedure and diagnosis codes. Validates and adjusts charges. Validates and adjusts charges. Responsible for abstracting data from medical records and working collaboratively with financial and clinical team members to ensure accurate financial billing. Provides education and training regarding coding guidelines to appropriate team members of their specialty area. Essential Functions
Consistently Meets Quarterly Productivity Standard:
• 95%
Consistently Meets Quarterly Quality Standard:
• 95%
Consistently Completes Quarterly Mandatory Coding Educations:
• 15 CEU - (Formal/Informal) Codes/charge outpatient records (Ambulatory Surgery, Observation, Emergency and Ancillary) according to coding guidelines and conventions. Assigns diagnoses and procedures for billing, data retrieval and research purposes, using numerical codes of ICD-9-CM/ICD-10-CM/PCS and CPT-4 coding. Provides education and training regarding coding guidelines of specialty area to clinical and non-clinical staff. Communicates, collaborates and acts as a team player with others in order to ensure continuity of services. Optimize codes for reporting and generates APCs for all outpatient records. Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Participate in process improvement activities including but not limited to assuring accounts that cannot be coded are held for valid reasons and documented accurately utilizing Unbilled Reason Codes (URCs)/GQ Flags Must attend all staff meetings required by Management
Qualifications
Required High School Diploma or equivalent
2 years of relevant experience Coding Required
CRT-Coding Specialist (CCS) - AHIMA American Health Information Management Association required Or CRT-Professional Coder - AAPC American Academy of Professional Coders required Or CRT-Outpatient Coder, Certified (COC) - UNKNOWN Unknown required Or CRT-Registered Health Information Technician (RHIT) - AAPC American Academy of Professional Coders required Or CRT-Registered Health Information Administrator (RHIA) - AHIMA American Health Information Management Association required
Primary Location
SITE - Business Service Center - th St - Grand Rapids
Department Name
Coding-Inpatient
Employment Type
Full time
Shift
Day (United States of America)
Weekly Scheduled Hours
40
Hours of Work
7 a.m. to 3:30 p.m.
Days Worked
Tuesday to Saturday OR Sunday to Thursday
Weekend Frequency
Every weekend
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Spectrum Health is committed to providing a safe environment for our team members, patients, visitors and community. That is why we require a drug-free workplace and various vaccinations as a requirement for employment.

Spectrum Health grants equal employment opportunity to all qualified persons without regard to race, color, national origin, sex, disability, age, religion, genetic information, marital status, height, weight, sexual orientation, veteran status, or any other legally protected category.

An interconnected, collaborative culture where all are encouraged to bring their whole selves to work, is vital to the health of our organization. As a health system, we advocate for equity as we care for our patients, our communities, and each other. From workshops that develop cultural intelligence, to our inclusion resource groups for people to find community and empowerment at work, we are dedicated to ongoing resources that advance our values of diversity, equity, and inclusion in all that we do. We invite those that share in our commitment to join our team.

If you are a qualified individual with a disability, you may request assistance in completing the application process by calling . We are committed to granting reasonable accommodations in accordance with applicable laws.

You could be the one who changes everything for our 26 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility.

Position Purpose: The focus of this position is to establish processes to respond to ICD-10 coding changes and its effect on inpatient claims payment. Chart review will include DRG pre-payment review, hospital readmission review and outlier payment review.

Analyze moderately complex health care information; reviews medical records; integrate medical coding and reimbursement rules; provide pricing guidance. Ensure medical coding rules and regulations including compliance requirements are adhered to for the appropriate handling of medical necessity, claims denials, and bundling issues. Provide regular reports on project status and progress; report project results to identify coding improvement opportunities. Collaborate with other business units to identify and implement process efficiency and quality improvement practices. Work with IT resources to implement system efficiencies and configuration enhancements to improve claims processing operations. Apply Coding Guidelines as described in the ICD-10 Coding Manual.

Education/Experience: RN Degree. One year experience preferred in hospital inpatient coding. Nursing experience in managed care organization or acute care hospital.

License/Certification: CPC Credential-Required; Valid/Current CPC Certification, through APPC-preferred; RHIA/RHIT Credentials-Preferred. RN Degree.

For Fidelis Care only: CCS or CPC current Credential-Required preferably credentialed by AHIMA or AAPC. RN Degree.

Our Comprehensive Benefits Package: Flexible work solutions including remote options, hybrid work schedules and dress flexibility, Competitive pay, Paid time off including holidays, Health insurance coverage for you and your dependents, 401(k) and stock purchase plans, Tuition reimbursement and best-in-class training and development.

Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law.
**TITLE:** Sr Certified Medical Coder RN

**LOCATION:** Various, Florida

**REQNUMBER:** 1340217

The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. This person possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. The Inpatient Coder II has a deep understanding of disease process, anatomy/physiology, pharmacology and medical terminology.
Responsibilities:

Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity.

Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.

Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation Improvement (CDI) Department who concurrently reviewed the record and provide their clinical insight on the diagnoses.

Utilizes resources within CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.

Reviews Discharge Planning and nursing documentation to validate and correct when necessary, the Discharge Disposition which impacts reimbursement under Medicare's Post-Acute Transfer Policy.

Utilizes knowledge of MS-DRG's, APR-DRG's, AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM's ranking in US News and World Report.

Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.

Educates CDI on regulatory guidelines, Coding Clinics and conventions to report appropriate ICD-10-CM diagnoses.

Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, medical terminology to determine the Principal Diagnosis, secondary diagnoses and procedures.

Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions and instructional notes to assign the appropriate diagnoses and procedures.

Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.

Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors.

Meets established coding productivity and quality standards.