Inpatient Coding Specialist

Gaylord Specialty Healthcare; Wallingford (CT); Hybrid; USD 70,000 - 90,000; Full time

Job summary

Gaylord Specialty Healthcare seeks an Inpatient Coding Specialist to join our HIM team. You will review inpatient records, assign ICD-10-CM diagnoses and ICD-10-PCS procedures per AHIMA standards and guidelines, and collaborate with clinicians to ensure accurate DRG assignments and compliant coding.

You will conduct physician queries, educate staff on documentation, and generate monthly reports to support revenue integrity and quality assurance.

Qualifications

• Associate's degree or equivalent in Health Information Management; Bachelor's preferred.
• Minimum 3 years of direct inpatient hospital coding experience.
• Credentialing: CCS, CCS-P, RHIT or RHIA through AHIMA or CPC preferred.
• Expertise with ICD-10-CM and ICD-10-PCS and Official Coding Guidelines.
• Keep up with official coding guidelines and continuing education to maintain certification.
• Proficient with EMR systems and coding references/software.
• Extensive CMS Hospital PPS knowledge and DRG assignment.

Responsibilities

• Review inpatient records and assign principal and secondary diagnoses and procedures upon admission, during stay, and at discharge.
• Apply PPS knowledge to ensure accurate DRG assignment and reimbursement.
• Communicate DRG assignments and changes to clinical staff.
• Collaborate with Utilization Management to ensure timely code assignment.
• Form physician queries to obtain missing documentation and clarification.
• Assist with payer requests for case review or DRG validation.
• Provide education to physicians and staff on coding requirements.
• Generate monthly reports and track trends for quality improvement.
• Participate in internal and external coding audits.

Skills

ICD-10-CM / ICD-10-PCS coding

Analytical thinking

Education

Associate's degree or equivalent in Health Information Management, Bachelor’s preferred

Tools

Electronic medical records

Coding references & software

Job description

Gaylord Specialty Healthcare is a health system dedicated exclusively to medical rehabilitation. We provide inpatient and outpatient care for people at every point in their journey from illness or injury to the most advanced state of recovery they can achieve. Our Mission: To enhance health, maximize function, and transform lives. Our values: Integrity, Compassion, Accountability, Respect and Excellence. These values guide us in providing quality patient care and transforming the lives of our patients.

SUMMARY

The Inpatient Coding Specialist reviews documentation in the electronic medical record and assigns ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes in accordance with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and in compliance with the ICD-10 Official Guidelines for Coding and Reporting, regulatory requirements, and Gaylord Hospital policy. Inpatient Coding Specialist will perform physician queries, obtain documentation clarification, and provide education to clinical staff on documentation requirements and DRG assignment. Works in collaboration with Clinical Documentation Integrity Specialist. Participates in quality monitoring and annual education/training.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Review inpatient medical record and assign appropriate principal and secondary diagnosis and procedure codes upon patient admission, concurrently throughout stay, and final code upon discharge in accordance with Official Coding Guidelines and regulatory requirements

• Utilize knowledge of Anatomy & Physiology, Pharmacology, and medical terminology to analyze physician and other clinical documentation to determine and support appropriate ICD-10-CM diagnosis and ICD-10-PCS procedure.
• Apply knowledge of Inpatient Prospective Payment System (PPS) to ensure accurate DRG assignment and appropriate reimbursement for inpatient admissions.
• Communicate DRG assignment and changes to clinical staff.
• Work in collaboration with the Utilization Management team to ensure timely code assignment to obtain working DRG.

Review clinical documentation in coordination with Clinical Documentation Integrity Specialist to ensure clinical documentation contains specificity, is accurate and complete

• Formulate a physician query to send to the provider to obtain missing documentation, specificity and/or additional clarification necessary to complete the coding process.
• Works collaboratively with Patient Financial Services to ensure accurate and timely claim submission.
• Assist with payer requests for case review or DRG validation. Draft correspondence to payer to support code assignment and appeal DRG downgrade.

Provide education and feedback to physicians and clinical staff

• Attend medical staff meetings or conduct physician in-service to provide training on coding or documentation requirements or changes.
• Act as subject matter expert on ICD-10-CM code assignment and serves as a resource for the organization for questions related to ICD-10 diagnosis coding and DRG assignment.
• Generate/complete monthly reports including Case Mix Index, Top DRG assignments, short-stays, DNFB, etc.
• Track monthly data to analyze trends or changes throughout the year.
• Perform internal quality assurance audits to verify accurate diagnosis code assignment for both inpatient and outpatient services. Assist with annual external coding compliance audits.

IT IS ICARE

• Innovation: Embracing creativity and new ideas to improve processes and outcomes.
• Teamwork: Collaborating effectively with others to achieve shared goals and objectives.
• Inclusion: Fostering an environment where everyone feels valued and supported.
• Safety: Prioritizing the well-being and security of patients, individuals and communities.
• Integrity: Acting with honesty and transparency in all interactions and decisions.
• Compassion: Showing empathy and kindness towards others, especially in challenging situations.
• Accountability: Taking responsibility for actions and outcomes, ensuring reliability and trust.
• Respect: Treating others with dignity and consideration, valuing their perspectives and contributions.
• Excellence: Striving for the highest quality in performance and achievements.

QUALIFICATIONS:

• Associate's degree or equivalent from a two-year College or technical school (Health Information Management), Bachelor’s degree preferred.
• Minimum 3 years of direct inpatient hospital coding-related experience.
• CCS (Certified Coding Specialist), CCS-P (Certified Coding Specialist), RHIT or RHIA through AHIMA preferred or CPC (Certified Coding Professional).
• Expertise with ICD-10-CM / ICD-10-PCS code assignment and Official Coding Guidelines.
• Current with official coding guidelines and attend continuing education necessary to maintain coding certification;
• Proficient with electronic medical records and utilizing coding references and electronic software applications.
• Must have an extensive knowledge of the CMS Hospital Prospective Payment System and DRG assignment.

HOURS:

Full time

Hybrid schedule (onsite and remote) after successful completion of the introductory period or at the manager’s discretion.