Medical Coder (East Coast United States resident / EST )

Geisinger; United States; Teletrabalho; USD 52 000 - 70 000; Tempo integral

Resumo da oferta

Geisinger is seeking a qualified Medical Coder I/II to review inpatient and outpatient records, translate clinical details into codes, and assign DRGs in compliance with coding guidelines. Responsibilities include querying physicians when documentation is unclear and using encoder software to maximize correct reimbursement.

Candidate should stay current with AHIMA/AAPC standards and be able to communicate new diagnoses and procedures to the Coding Quality team.

Qualificações

• One relevant certification from AHIMA or AAPC is required upon hire.
• Acceptable AHIMA certifications include CCS, CCS-P, RHIT, RHIA, and CCA with conditions.
• AAPC certifications are acceptable except certain listed credentials.

Responsabilidades

• Review medical records to identify principal/secondary diagnoses and procedures for accurate coding.
• Translate diagnostic and procedural phrases into codes using standard guidelines.
• Determine codes and DRGs using encoder software and optimize reimbursement.
• Query physicians to clarify documentation when needed.
• Stay current with coding guidelines and recommend improvements.
• Communicate new diagnoses/procedures to coding leadership.
• Update historical data via claim action reports.

Conhecimentos

Medical coding

Documentation review

Clinical documentation improvement

Ferramentas

Encoder software

Descrição da oferta de emprego

• 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 using 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.
• Reviews coding guidelines on an annual basis and makes recommendations for change to improve coding and data management.
• 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.
• Updates and corrects historical file data by completing and submitting claim action reports per the PHC4 quarterly report.

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).

This posting reflects an opening for Coder I and we are seeking candidates for that position. Geisinger reserves the right to consider applicants for higher levels of this role based on their skills, qualifications, and experience.

Coder Level II requirement:

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 (American Academy of Professional Coders) 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)