Job description
Overview:
Infection Control: Initial and Ongoing training in dealing with infection control. Trainings could include but are not limited to, blood borne pathogens, bodily fluids and bio hazardous materials as it applies to your daily work environment.
Patient Interaction: None
HIPAA: This position will have access to the following Protected Health Information in order to carry out the duties related to their position at HaysMed based on the following criteria: Primary - required (routine) to do the job Secondary - required for the job, but mostly be exception None - no approved access Description of Information Level Primary: Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion Financial Information/Insurance (information related to insurance, billing and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates Clinical Information (information that describes a patient's health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, ICD-10-CM , ICD-10-PCS, Rev Codes, CPT Codes. Qualifications:
Analyzes medical records in order to code and abstract medical information to be submitted to financial reimbursement as required for the Uniform Bill and for the DRG/Prospective Payment System.
Position Summary:
- Reads and reviews health records, identifies appropriate diagnoses and procedures and assigns appropriate codes
- Abstracts clinical data from health records and assigns appropriate ICD-10-CM and ICD-10-PCS codes. These codes are used for classification, reimbursement, strategic planning, and research
- Works collaboratively with clinical documentation program to achieve accurate DRG assignment and appropriate mortality and severity scores
- Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM/PCS coding guidelines to inpatient and outpatient diagnoses and procedures
- Correlates information from approved supporting clinical documentation not limited to Pathology, Radiology, and/or other Physician Consultations after review by the Attending Physician, wherever appropriate
- Abstracts all clinical data with high degree of accuracy to be utilized in research and benchmarking by the hospital as well as numerous third parties such as KHDE, HIDI, and CMS
- Communicate with nursing and ancillary services personnel for needed documentation for accurate coding
- Provides real-time feedback to surgical/procedural providers as it pertains to proper coding and clinical documentation of services performed
- Maintains and processes claim edits to assure timely billing
- Works collaboratively to achieve minimum bill days from discharge/service date for inpatient/outpatient accounts
- Coders maintain prioritized workflow through cooperative work distribution (i.e. prioritization of charts by discharge date and total charges)
- Performs other related duties incidental to the work described herein
Infection Control: Initial and Ongoing training in dealing with infection control. Trainings could include but are not limited to, blood borne pathogens, bodily fluids and bio hazardous materials as it applies to your daily work environment.
Patient Interaction: None
HIPAA: This position will have access to the following Protected Health Information in order to carry out the duties related to their position at HaysMed based on the following criteria: Primary - required (routine) to do the job Secondary - required for the job, but mostly be exception None - no approved access Description of Information Level Primary: Patient Demographic Information (information used to identify a person): Name, Date of Birth, Address, Race, Marital Status, Religion Financial Information/Insurance (information related to insurance, billing and payment): Billing Information, Payer Name, Payer ID, Account Balances, Plan Elements Covered, Payment Information, Payment Rates Clinical Information (information that describes a patient's health status): Diagnosis, Reports/Medical Notes, Test Results, Problem List, Procedures, History and Physical Coding Information (clinical information that is in (alpha) numeric format): ICD-9 Codes, ICD-10-CM , ICD-10-PCS, Rev Codes, CPT Codes.
Required:
- CCS, RHIT, or RHIA certification required
- Associate degree
- Additional certification may be required for certain patient care settings or populations
Preferred:
- Bachelor’s degree
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