Job Summary :
The Coder is responsible for reviewing and analyzing medical records in order to abstract relevant data from patient medical records and ensuring appropriate codes are assigned in accordance with the clinical coding system to enable accurate and optimal allocation of Diagnosis Related Group (DRG) or associated Casemix classifications for all care episodes.
The individual is also responsible for working closely with quality, finance, revenue cycle departments, registration, scheduling, case management, coding coordinators, coding reconciliation specialists and compliance to resolve coding / billing issues.
He / she investigates and resolves problems, complaints and incidents occurring within the coding section and assists the Manager Coding with resolution of such issues.
Key Role Accountabilities :
Reviews and interprets patient EMR documentation to identify pertinent diagnoses and procedures and assigns ICD-10-AM and ACHI codes accurately and timely to the highest level of specificity based upon physician documentation
Reviews for document deficiencies and communicates policies and guidelines to physicians to improve documentation; including direct interaction with the relevant clinicians
Ensures timely, accurate, and complete clinical data for direct activity reporting, quality initiatives, billing, reimbursement, utilization and patient information systems
Ensures accurate coding and sequencing as specified by established coding principles and guidelines, following the clinical coding system to derive the appropriate DRG or similar care classification system required.
Ensures implementation of coding productivity and quality guidelines, including audits, to ensure timeliness and accuracy of final diagnoses
Assists the Manager Coding with the review process including record review, report generation and other duties as needed
Allocates the appropriate specific codes from the indexing system and assigns the codes for completing coding summary of the medical records
Investigates and resolves problems, complaints and incidents occurring within the coding section, and reports these occurrences to the Manager Coding
Ensures consistency in information data flow and documentation requirements for effective medical coding and grouping; including development of advice sheets for clinicians to highlight key issues.
Validates that encoded information is reported with the most accurate information
Ensures continuous studies on coding practices and coding schemes to enhance the accuracy and timely completion of coding data
Ensures prioritization of coding tasks and designates work assignments to the Coders
Monitors daily coding compliance record reviews
Leads the coding reconciliation processes
Creates reports on unbilled records due to documentation, charge errors, and registration errors
Reports the number of DRG / coding changes below Sidra’s specified threshold to the Manager - Coding
Assures codes are supported by provider documentation and initiates appropriate queries based upon other clinical documentation for accurate and reliable data collection and reimbursement
Monitors coding systems to ensure optimal performance and recommends upgrades or changes to current system
Acts as a resource for coders to address coding related issues and questions
Implements changes in coding rules regarding correct coding initiatives and coding clinics as received from the Manager Coding
Stays abreast of changes in laws, regulations and policies that impact clinical documentation, reimbursement and coding to assure compliance
Monitors the coding / abstracting systems and ensures that appropriate computer systems are updated with the annual code changes and any other associates changes or updates
Implements and monitors policies and procedures, guidelines and compliance plan for coding; ensures coding processes are compliant and efficient
Works cooperatively with revenue cycle departments, registration, scheduling, case management, coding coordinators, coders, coding reconciliation specialists and compliance officer to resolve coding / billing issues
Adheres to Sidra’s standards as they appear in the Code of Conduct and Conflict of Interest policies
Adheres to and promotes Sidra’s Values
In view of the evolving needs and opportunities within Sidra, this position may be required to perform other duties as assigned and reporting relationships may vary.
Qualifications, Experience and Skills :
Bachelor’s Degree in a relevant field
5+ years’ experience in coding clinical information systems inclusive of 2+ years senior lead experience in HIM / Coding
Certification and Licensure
Credentialed Coder Certificate (CPC, CCS) Registered Health Information Certificate (RHIT, RHIA)
Job Specific Skills and Abilities