Medical Coder - Inpatient DRG (IPDRG)_Onsite_Dayshift_BGC_Up to 120K

weSource Management Consultancy Firm; Taguig; On-site; PHP 30,000 - 40,000; Full time

Job summary

A healthcare staffing solution provider seeks an experienced Inpatient DRG Coder in Metro Manila, Philippines. Candidates must have at least 2 years of coding experience, possess relevant certifications, and demonstrate proficiency in medical terminology and coding systems. Key responsibilities include coding inpatient records, adhering to HIPAA standards, and collaborating with healthcare teams. Strong analytical skills and excellent English communication are essential for this role.

Qualifications

• At least 2 years of Inpatient DRG Coding experience.
• Active Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC) certification required.
• Extensive knowledge of medical terminology and coding.

Responsibilities

• Perform coding for inpatient health records using guidelines.
• Ensure compliance with HIPAA standards.
• Communicate with healthcare providers for additional information.

Skills

Inpatient DRG Coding experience

Excellent verbal and written English communication

Attention to details

Analytical and critical thinking skills

Education

Bachelor of Science in the allied health field

Masters degree or credential in business or healthcare

Tools

Electronic medical records (EMR) like Epic, Cerner, Meditech

Microsoft Office Suite

Encoder software (3M/Solventum, Encoder Pro, Codify)

Job description

Main Requirements

• Coding Experience: At least 2 years of Inpatient DRG Coding experience.
• Education: Bachelor of Science in the allied health field.
• Credential/Certification: ActiveCertified Coding Specialist (CCS) or Certified Inpatient Coder (CIC), or Certified Documentation Improvement Practitioner (CDIP)
• RCM Knowledge: Extensive, comprehensive working knowledge of medical terminology, Anatomy and Physiology, diagnostic and procedural coding, and MS-DRG, APR DRG assignment. Must be proficient in identifying POA, SOI, and ROM indicators for Inpatient records as well as HACs and PSIs to ensure accurate hospital reimbursement. Familiarity with HIPAA regulations.
• Software Knowledge: Proficiency with electronic medical records (EMR) such as Epic, Cerner, or Meditech.
• Excellent verbal and written English communication skills and customer service skills (CEFR level of at least B2 for both verbal and written)

Preferred skills/expertise

• Education: Masters degree or credential in business, healthcare, or related field preferred
• Licensure: Registered Nurse with an active PHRN or USRN license preferred.
• Software Knowledge: Current experience utilizing encoding/grouping software and Computer Assisted Coding (CAC) is preferred. Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred. Proficiency with the Microsoft Office suite (Excel, Word, PowerPoint, Outlook, SharePoint).
• RCM Knowledge: Prior experience with US healthcare providers or payers.

Other Requirements

• Ability to pay close attention to details; strong follow-up and follow-through skills
• Regularly makes complex decisions within the scope of the position, and comfortable working independently
• Requires the use of independent judgment, discretion and decision-making abilities
• Demonstrates teamwork and integrity in all work-related activities
• Ability to interact with internal and external customers in a professional manner
• Strong analytical and critical thinking skills.
• Experience in a matrixed environment
• Excellent English written and verbal communication skills

Responsibilities

Documentation Review and Code Assignment

• Assign appropriate code(s) by utilizing coding guidelines established by:
  • The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting
  • American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
  • American Health Information Management Association (AHIMA) Standards of Ethical Coding
  • Revenue Excellence/HM coding procedures and guidelines
• Navigate the patient health record and other computer systems/sources to accurately determine diagnosis and procedure codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.
• Code Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators.
• Review Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.
• Work on inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
• Adhere to the Inpatient coding quality and productivity standards established by the organization.
• Safeguard patient health information in compliance with HIPAA standards.

Query Management & Follow-Up

• Demonstrate knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS) or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.
• Utilize EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.

HIM Collaboration

• Work with HIM and Patient Financial Services (PFS) teams, when needed, to help resolve billing, claims, denial, and appeals issues affecting reimbursement.