Clinical Coding Specialist I - Health Information Management - Full Time
Saint Joseph Health System, Plymouth indiana
Minimum: $16.94 - Maximum: $24.49
Analyzes physician/provider documentation contained in assigned ancillary outpatient electronic health records to determine the first listed and all secondary diagnoses. Utilizes encoder software applications (including online references) in the assignment of ICD-10/PCS codes and CPT-4®/HCPCS procedure codes for appropriate APC assignment.
Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA), and Unified Revenue Organization/Ministry Organization (URO/MO), ICD-10/PCS - International Classification of Diseases, 9th Revision, Clinical Modification, CPT - Current Procedural Terminology, APC - Ambulatory Payment Classification, AHIMA – American Health Information Management Association.
1. Actively demonstrates the organization’s mission and core values, and conducts oneself at all times in a manner consistent with these values.
2. Knows and adheres to all laws and regulations pertaining to patient health, safety and medical information.
3. Navigates the electronic patient health record and other computer systems in determination of diagnoses and procedures to be coded.
4. Codes routine Outpatient health records utilizing encoder software and online tools and references in the assignment of ICD-10/PCS codes.
5. Validates charges by comparing charges with health record documentation as necessary.
6. Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtained from the health record.
7. Communicates effectively with clinical staff, physicians and office staff regarding documentation issues or needs.
8. Collaborates with Regional Shared Services (HIM and Patient Financial Services) in resolving billing and utilization issues affecting reimbursement.
9. Identifies concerns and notifies appropriate leadership for resolution.
10. Tracks issues (i.e., missing documentation or charges) that require follow-up to facilitate coding in a timely fashion.
11. Meets coding quality and productivity standards established by SJHS.
12. Abides by confidentiality requirements as they relate to the release of individual or aggregate patient information.
13. Maintains up-to-date knowledge of changes in coding guidelines and regulations.
14. Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
15. Performs other duties consistent with purpose of job as directed.
JOB SPECIFICATIONS AND CORE COMPETENCIES
Education : High school diploma or equivalent combination of education and experience is required. Certified Coding Associate (CCA), Associate’s or Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.
Licensure : CCA, CCS, CPC-H, RHIT or RHIA required.
Experience : Working knowledge of medical terminology, Anatomy and Physiology and basic diagnostic and procedural coding obtained either through current coding experience or education or a coding certificate program is preferred. One (1) to two (2) years of current coding experience or experience working in a healthcare setting is preferred. Current experience doing remote coding is a plus. Current experience utilizing encoding/grouping software is preferred. Ability to utilize both manual and automated versions of the ICD-10/PCS and CPT4 coding classification systems is preferred.
Other Job Requirements :
Ability to use a standard desktop and windows based computer system, including a basic understanding of e-mail, internet, and computer navigation. Ability to use other software as required to perform the essential functions on the job. Familiarity with distance learning or using web-based training tools desirable.
Well-developed communication skills, both written and oral, that may be used either on-site or in virtual working environments. Able to communicate effectively with individuals and groups representing diverse perspectives.
Ability to work with minimal supervision and exercise independent judgment
Ability to research, analyze and assimilate information from various on-site or virtual sources based on technical and experience-based knowledge. Must exhibit critical thinking skills and possess the ability to prioritize workload.
Excellent organizational skills. Ability to perform multiple duties and functions related to daily operations and maintain excellent customer service skills. Ability to perform frequent detailed tasks and provide immediate service with frequent interruptions. Ability to change and be flexible with work priorities. Strong problem solving skills.
Must be comfortable functioning in a virtual, collaborative, shared leadership environment.
Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.
Must be able to set and organize own work priorities, and adapt to them as they change frequently. Must be able to work concurrently on a variety of tasks/projects in physical or virtual environments that may be stressful with individuals having diverse personalities and work styles.
If applicable, telecommuting (working remotely), must be able to comply with Trinity Health’s and the Region/MO Working Remote Policy.
Assigned hours within your shift, starting time, or days of work are subject to change based on departmental and/or organizational needs.