Inpatient Coder II, HB coding

Northwestern Medicine; Chicago (IL); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Northwestern Medicine seeks an Inpatient Coder II to serve as the coding and reimbursement expert for ICD-10-CM and ICD-10-PCS for complex inpatient acute care discharges.

You will review documentation, assign accurate codes, and ensure proper POA values, leveraging CAC software and understanding MS-DRG/APR-DRG, CMS guidelines, and CDI input.

Qualifications

• 3 years of inpatient coding experience in an acute healthcare setting.
• RHIA, RHIT or CCS credential is required.
• AHIMA membership required.
• Associate's degree is preferred.
• RHIA/RHIT with CCS or CDIP/CCDS credential is preferred.
• 4 years inpatient coding experience in a teaching hospital is preferred.

Responsibilities

• Assign ICD-10-CM diagnoses and ICD-10-PCS procedures for complex inpatient discharges.
• Determine POA values for secondary diagnoses for quality metrics.
• Review provider notes and CDI input for accurate coding.
• Utilize CAC software to review documentation and select codes.
• Review discharge planning documentation to validate discharge disposition for Medicare reimbursements.
• Sequence codes within top 24 fields using MS-DRG/APR-DRG and risk adjustment concepts.
• Collaborate with CDI on discharge diagnoses for 45% of cases.
• Educate CDI on coding guidelines and conventions.
• Interpret documentation to determine principal and secondary diagnoses and procedures.
• Follow official guidelines to assign correct diagnoses and procedures.
• Prepare appeal letters in response to payor DRG downgrades.
• Resolve nosology messages and coding validation warnings.
• Meet established coding productivity and quality standards.

Education

RHIA, RHIT or CCS credential

AHIMA membership

Associate's degree (preferred)

RHIA or RHIT with CCS or CDIP/CCDS credential

4 years inpatient coding experience in teaching hospital (preferred)

Tools

CAC software

Job description

Description

The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. Possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. Has a deep understanding of disease process, anatomy/physiology, pharmacology and medical terminology.

RESPONSIBILITIES:

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II's typically see average CMI's of 2.2609. This index score demonstrates higher patient complexity and acuity.
• Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.
• Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation Improvement (CDI) Department who concurrently reviewed the record and provide their clinical insight on the diagnoses.
• Utilizes resources within CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.
• Reviews Discharge Planning and nursing documentation to validate and correct when necessary, the Discharge Disposition which impacts reimbursement under Medicare's Post-Acute Transfer Policy.
• Utilizes knowledge of MS-DRG's, APR-DRG's, AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM's ranking in US News and World Report.
• Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.
• Educates CDI on regulatory guidelines, Coding Clinics and conventions to report appropriate ICD-10-CM diagnoses.
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, medical terminology to determine the Principal Diagnosis, secondary diagnoses and procedures.
• Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions and instructional notes to assign the appropriate diagnoses and procedures.
• Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.
• Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors.
• Meets established coding productivity and quality standards.

Qualifications

Minimum Requirements:

Certification:

• RHIA, RHIT or CCS credential
• AHIMA membership

Experience:

• 3 years of inpatient coding experience in an acute healthcare setting

Preferred:

• Associate's degree in related field
• RHIA, RHIT with CCS or CDIP/CCDS credential
• 4 years of inpatient coding experience in a teaching hospital

Equal Opportunity

Northwestern Medicine is an equal opportunity employer (disability, VETS) and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

Background Check

Northwestern Medicine conducts a background check that includes criminal history on newly hired team members and, at times, internal transfers. If you are offered a position with us, you will be required to complete an authorization and disclosure form that gives Northwestern Medicine permission to run the background check. Results are evaluated on a case-by-case basis, and we follow all local, state, and federal laws, including the Illinois Health Care Worker Background Check Act.

Artificial Intelligence Disclosure

Artificial Intelligence (AI) tools may be used in some portions of the candidate review process for this position, however, all employment decisions will be made by a person.

Benefits

We offer a wide range of benefits that provide employees with tools and resources to improve their physical, emotional, and financial well-being while providing protection for unexpected life events.

Click on or copy and paste URL to your browser to view detailed benefits information https://jobs.nm.org/benefits

Please refer to the Benefits Eligibility by Employment Classification to determine benefits eligibility for job postings.

If sign-on bonus is included in a job posting eligibility is as followed: Internal employees and rehires who left Northwestern Medicine within 1 year are not eligible for the sign-on bonus. Exception: New graduate internal employees seeking their first licensed clinical position as a Registered Nurse at NM may be eligible.