Inpatient Coder 3 Certified / HIM Coding

AAPC; United States; On-site; USD 65,000 - 90,000; Full time

Job summary

Hartford HealthCare is seeking an Inpatient Coder to review inpatient clinical documentation and assign ICD-10-CM diagnoses and ICD-10-PCS procedures. You will determine MS-DRG assignments and support regulatory compliance and reimbursement.

Responsibilities include collaborating with CDS and billing teams, applying UHDDS standards, and ensuring adherence to coding guidelines and ethical standards. This role reports to the Inpatient Coding Manager and may involve mentoring newer coders.

Responsibilities

• Applies strong knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis and procedure codes for more complex accounts.
• Analyzes medical records using UHDDS, interprets documentation and assigns ICD-10-CM diagnoses and ICD-10-PCS codes using designated software including CAC/encoder, coding manuals and reference materials.
• Reviews DRG assigned to each record, enters coded information, analyzes DRG groupings, and observes for correct DRG assignment.
• Handles high-dollar and complex cases including medical, surgical, behavioral health and IP Rehabilitation.
• Applies IRF-PAI guidelines for IP Rehabilitation coding.
• Adheres to department coding procedures, policies, guidelines and quality standards; follows AHIMA/ACPC coding standards.
• Meets revenue cycle goals (KPIs and Productivity Standards).
• Issue Resolution: completes assigned review edits on a daily basis.
• Communication: collaborates with CDS to determine DRG assignments for compliance and reimbursement, works with Billing Registration and other departments, seeks physician clarification when documentation is incomplete or contradictory.
• Training: assists in training and mentoring new coders to acclimate to the environment and internal policies.

Job description

Inpatient Coder

Work where every moment matters. Every day, more than 40,000 Hartford HealthCare colleagues come to work with one thing in common: Pride in what we do, knowing every moment matters here. We invite you to become part of Connecticut's most comprehensive healthcare network.

Position Summary: Reviews inpatient clinical documentation to determine the appropriate assignment of alpha numeric diagnosis/procedure codes and Medicare Severity Diagnosis Related Groups (MS-DRG). Data is classified for internal and external statistical reporting, research, regulatory compliance and reimbursement.

Position Responsibilities

Key Areas of Responsibility

• Applies strong knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis and procedure codes for more complex accounts.
• Analyzes medical records using the Uniform Hospital Discharge Data Set (UHDDS), interprets documentation and assigns proper International Classification of Diseases, Tenth Edition, Clinical Modification (ICD-10-CM) diagnoses and ICD-10-Procedural Classification System (PCS) operative procedure codes utilizing designated software to included Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material.
• Reviews DRG assigned to each record. Enters coded/abstracted information into software, analyzes DRG groupings, and observes for appropriate DRG assignment.
• Reviews high dollar and more complex cases including but not limited to, medical, surgical, behavioral health and IP Rehabilitation.
• Applies IRF-PAI guidelines for IP Rehabilitation coding.
• Adheres to all department coding procedures, policies, guidelines and quality standards.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines.
• Meets revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

Issue Resolution: Complete on a daily basis cases that have been assigned for review of edits, etc.

Communication

• Collaborates with clinical documentation specialists (CDS) to determine appropriate DRG assignment for compliance and reimbursement purposes.
• Collaborates with Quality Management and other departments (Billing Registration, etc.) as required.
• Seeks clarification from attending physician in cases where documentation is absent, ambiguous, or contradictory.

Training

• Assists in training and mentoring new coders to become acclimated to new environment, and understand internal coding policies and procedures

Working Relationships: This position reports to Inpatient Coding Manager