Coder Senior - Professional Coding and Auditing experienced (Eastern United States resident)

Geisinger; Danville (PA); On-site; USD 75,000 - 100,000; Full time

Job summary

Geisinger in Danville, PA seeks a highly experienced medical coder to review records, assign codes, and ensure compliant documentation for inpatient and outpatient encounters. The role requires translating clinical narratives into accurate codes and DRG determination to optimize reimbursement.

Minimum 7 years of coding experience and AHIMA or AAPC certification are required, with proficiency in Encoder software.

Qualifications

• Minimum of 7 years of relevant experience in medical coding.
• High School Diploma or GED required.
• AHIMA or AAPC coding certification required upon hire.

Responsibilities

• Review hospital and professional records to identify principal and secondary diagnoses and procedures.
• Translate clinical phrases into standardized codes for claims and reporting.
• Determine code sequencing to maximize appropriate reimbursement and assign DRG.
• Query physicians to clarify documentation for accurate coding.
• Utilize Encoder software to assign codes and ensure compliance with coding guidelines.
• Provide training and guidance to coding staff on guidelines and documentation.

Skills

Medical coding

Education

High School Diploma or GED

AHIMA/AAPC coding certification

Tools

Encoder software

Job description

Job Summary

Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures.

Job Duties

• Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply with standard provider coding regulations.
• Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses and procedures are recorded.
• Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes as required.
• Using the Encoder software program, determines the codes for all diagnoses and procedures.
• Determines their sequencing to legally maximize reimbursement.
• Assigns the appropriate DRG.
• Assigns codes based on hospital and professional coding guidelines, Coding Clinic directives, federal regulations, CCI coding initiatives, CPT Assistant or other standard coding guidelines.
• Queries physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding.
• Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies, etc.
• documented within patient records to ensure that appropriate diagnosis and procedure codes are selected and incorporated into hospital and professional coding guidelines.
• Provides and arranges training for coding professionals in the use of coding guidelines and practices, proper documentation techniques, medical terminology, and disease processes.
• Completes coding quality audit reviews to ensure all available cases were coded and entered into the hospital and professional computer system correctly and initiates Claim Action Reports as necessary.
• Develops coding policy and procedure or position papers related to correct coding for new or emerging technology services provided by clinical staff, and train coders on the use of that policy and procedure.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).

Position Details

Minimum of One relevant certification from AHIMA or AAPC is required upon hire. Acceptable certifications include:

AHIMA (American Health Information Management Association)

• Certified Coding Specialist (CCS)
• Certified Coding Specialist – Physician-based (CCS-P)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)
• Certified Coding Associate (CCA) – Candidates with only a CCA are required to obtain a CCS, RHIT, or RHIA within 12 months of hire.

All certifications are acceptable from AAPC except:

• Scribe, Documentation, Instructor, and International Credentials
• Certified Professional Biller (CPB)
• Revenue Cycle Management Specialist (RCMS)
• Certified Value-Based Administrator (CVBA)
• Certified Physician Practice Manager (CPPM)
• Certified Professional Compliance Officer (CPCO)

Education

High School Diploma or Equivalent (GED)- (Required)

Experience

Minimum of 7 years-Relevant experience* (Required)

Certification(s) and License(s)

Relevant coding certification - Default Issuing Body

OUR PURPOSE & VALUES

Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities. KINDNESS: We strive to treat everyone as we would hope to be treated ourselves. EXCELLENCE: We treasure colleagues who humbly strive for excellence. LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow. INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation. SAFETY: We provide a safe environment for our patients and members and the Geisinger family. We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, from senior management on down, we encourage an atmosphere of collaboration, cooperation and collegiality. We know that a diverse workforce with unique experiences and backgrounds makes our team stronger. Our patients, members and community come from a wide variety of backgrounds, and it takes a diverse workforce to make better health easier for all. We are proud to be an affirmative action, equal opportunity employer and all qualified applicants will receive consideration for employment regardless to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or status as a protected veteran.