HB-PB Coding Specialist II - ED Facility/Profee

WVU Medicine; Lubbock (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a Hospital Coder to ensure accurate coding assignments and compliant documentation across inpatient, observation and outpatient encounters. Responsibilities include complex coding, audits, and collaboration with physicians to optimize reimbursement.

Ideal candidates hold AHIMA/AAPC certification, at least two years of coding experience, and the ability to maintain accuracy under pressure in a fast-paced hospital setting.

Qualifications

• High School Diploma or Equivalent.
• Current HIM or Coding Certification through AHIMA or AAPC.
• Two (2) years of medical coding experience; physician office coding preferred.

Responsibilities

• Reviews and interprets medical record documentation to assign ICD‑10, CPT, or modifiers for diagnoses/procedures.
• Performs the coding/billing Split Claims process for correct coding and reimbursement.
• Ensures quality, coding, charging and abstraction of accounts daily for assigned areas.
• Maintains coding knowledge through trainings, seminars, and reference materials updates.
• Ensures data accuracy for clean billing and communicates with physicians to obtain information.
• Monitors provider documentation, conducts audits, and educates providers as needed.
• Supports Revenue Cycle in claim development to resolve problem accounts.

Skills

Medical coding

Attention to detail

Analytical skills

Communication skills

Independent decision making

Prioritization

Adaptability

Time management

Anatomy & physiology knowledge

Education

High School Diploma or Equivalent

HIM or Coding Certification (AHIMA/AAPC)

Job description

To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospitals, clinics and outside agency requirements, this role includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. The position is responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record.

This position is an integral part of an overall compliance program effort as it pertains to hospital/physician coding and billing functions. It will interact with physician and non‑physician providers to maximize correct coding initiatives along with hospital coding, analyze and resolve issues of missing charges and problem accounts by researching department reimbursement, code more complex patient classes (inpatient, observations, same day care, etc.), and handle Split Claim processes required for Critical Access hospitals.

MINIMUM QUALIFICATIONS

Education, Certification, and/or Licensure: High School Diploma or Equivalent.

Current HIM or Coding Certification through one of the following: American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC).

EXPERIENCE

Two (2) years of medical coding experience.

Preferred: Two (2) years of physician office coding experience.

CORE DUTIES AND RESPONSIBILITIES

• Reviews and accurately interprets medical record documentation from all accounts, identifies all diagnosis and procedures that affect the current inpatient stay or outpatient encounter, and assigns the appropriate ICD‑10, CPT, or modifier codes for each diagnosis and procedure. Assigns hospital and/or professional codes to a variety of patient classes (i.e. I/P, OBS, SDC, etc.).
• Performs the coding/billing Split Claims process to ensure correct coding and reimbursement for appropriate accounts.
• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
• Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in‑services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
• Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
• Contacts physicians or any persons necessary to obtain information required to accurately code assignments and works and communicates with other offices as needed to facilitate the billing process.
• Monitors provider documentation on an on‑going basis, performs audits to assess provider coding accuracy and follows up with provider education as needed.
• Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

PHYSICAL REQUIREMENTS

• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within the normal range.
• Must have manual dexterity needed to operate computer and office equipment.
• Must be able to lift, push or pull 10‑20 pounds.

WORKING ENVIRONMENT

• Standard office environment.
• Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
• May require travel.

SKILLS AND ABILITIES

• Must be able to concentrate and maintain accuracy during constant interruptions.
• Must possess independent decision‑making ability.
• Must possess the ability to prioritize job duties.
• Must be able to handle high stress situations.
• Must be able to adapt to changes in the workplace.
• Must be able to organize and complete assigned tasks.
• Must possess excellent written and verbal communication skills.
• Must meet quality and productivity standards.
• Must possess knowledge of anatomy, physiology and medical terminology.

ADDITIONAL JOB DESCRIPTION

Scheduled Weekly Hours: 40

Exempt/Non‑Exempt: United States of America (Non‑Exempt)

Shift: United States of America (Non‑Exempt)

Company: SYSTEM West Virginia University Health System

Cost Center: 548 SYSTEM HIM Coding Analysis