Coder I - MPG - FT - Days - MSS - Remote Eligible

Memorial Hospital West; United States; Remote; USD 52,000 - 72,000; Full time

Job summary

Memorial Hospital West in Miramar, Florida seeks an experienced Health Information Management (HIM) coder to review and code medical records for physician billing and hospital encounters. You will ensure accurate coding for diagnoses, procedures and modifiers, and communicate with insurers regarding disputes.

The role requires AHIMA credentials such as CCA/CCS/RHIA/RHIT or equivalent, plus hospital outpatient coding experience.

Qualifications

• High School Diploma or Equivalent required.
• AHIMA certifications (CCA/CCS/RHIA/RHIT) preferred or required.
• Knowledge of coding classifications and procedures.

Responsibilities

• Audit and/or coding reviews with health care professionals.
• Communicate with insurers about coding errors and disputes.
• Abstract data points for billing and quality reviews.
• Collaborate with departments to ensure patient data accuracy.
• Submit daily productivity reports to HIM manager.
• Maintain coding quality and productivity standards.
• Participate in continuing education to maintain certification.

Skills

Accountability

Accuracy (DRG)

Accuracy - Coder

Analysis and decision making

Customer service

Effective communication

HIM systems - coder

Medical terminology

Team work

Education

High School Diploma or Equivalent

CCA - AHIMA

CCS - AHIMA

RHIA - AHIMA

RHIT - FL

RHIT AHIMA

Job description

Location

Miramar, Florida

Summary

Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.

Responsibilities

• Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing).
• Communicates with insurance companies about coding errors and disputes (physician billing).
• Abstracts pertinent data points for billing and quality reviews.
• Communicates with various departments as needed to ensure accuracy of patient data.
• Submits daily productivity report to HIM manager by defined deadline.
• Meets and maintains HIM coding quality and productivity standards.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
• Enhances and maintains coding knowledge and skills.
• Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• For physician billing, collaborates with billing department to ensure all bills are satisfied.
• For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing.
• Makes appropriate coding corrections, when advised, and follows procedure to notify billing.
• Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments.
• For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding.
• Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes.
• May assign and sequence basic CPT (Current Procedural Terminology) procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures.
• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments.
• Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity.
• Researches medical record for any additional diagnoses documented to meet medical necessity.

Competencies

• ACCOUNTABILITY
• ACCURACY (DRG)
• ACCURACY - CODER
• ACCURACY - OUTPATIENT
• ANALYSIS AND DECISION MAKING
• CUSTOMER SERVICE
• EFFECTIVE COMMUNICATION
• HEALTH INFORMATION MANAGEMENT (HIM) SYSTEMS - CODER
• HEALTH INFORMATION MNGMT
• MEDICAL RECORD CODING
• MEDICAL TERMINOLOGY (1)
• PRODUCTIVITY - IP CODING
• RESPONDING TO CHANGE
• STANDARDS OF BEHAVIOR
• TEAM WORK

Education and Certification Requirements

• High School Diploma or Equivalent (Required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)
• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA)
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA)
• Registered Health Information Technician (RHIT) - State of Florida (FL)
• Registered Health Information Technician (RHIT AHIMA) - American Health Information Management Association (AHIMA)

Additional Job Information

Complexity of Work: Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills. Ability to perform job duties using an electronic medical record system. Strong knowledge of anatomy, physiology and medical terminology. Knowledge of coding classification systems and procedures.

Required Work Experience

For HIM coder, one (1) year hospital-based outpatient coding experience. For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System.

Other Information

For HIM: Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS) or Certified Coding Associate (CCA).For Physician Billing: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified R