Senior Inpatient Coder

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 85,000 - 120,000; Full time

Job summary

Westchester Medical Center Health Network is seeking an experienced Senior Inpatient Coder to address insurance denials and code complex records using ICD-10-CM/PCS. The role includes providing technical guidance and leading coding activities in collaboration with hospital staff.

The ideal candidate holds a CCS certification, minimum three years in inpatient acute care coding, and strong knowledge of AHA guidelines.

Qualifications

• Minimum of three years in inpatient coding in acute care.
• Proficient in ICD-10-CM and ICD-10-PCS coding.
• Pass coding assessment before hire.
• Current CCS certification required; RHIA/RHIT preferred.
• Ability to train junior coders and guide others.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies AHA guidelines to support diagnoses and procedures.
• Analyzes patterns in coding errors and reports to leadership.
• Participates in mandated medical record review processes.
• Assigns and records accurate codes for diagnoses and procedures as documented by the attending physician.
• Queries physicians for documentation clarification.
• Ensures factors for DRG assignment are present and diagnoses ranked properly.
• Contacts to obtain clarifications.
• Compiles and updates the appeal log detailing denials, hospital's reply, and follow-up responses.
• Provides information to staff regarding documentation and DRGs.
• Abstracts information to compile reports.
• May train lower level coders and provide guidance.
• Resolves bill holds to maintain DNFB and coding queue.
• Acts as liaison between Patient Accounting and Coding.

Skills

ICD-10-CM/PCS coding

Inpatient coding

Leadership / training

Communication skills

Education

High School diploma

30 credits toward Associate/Bachelor degree

Tools

Grouper system

AHA Guidelines

Job description

Job Summary

The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the current International Classification of Diseases (ICD10 CM/PCS codes) and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected. Does related work as required.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures.
• Identifies and analyzes patterns in possible coding errors or other trends and reports to the the coding leadership team.
• Participates in mandated medical record review processes.
• Using current ICD10 CM/PCS coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
• Queries physicians for documentation clarification
• Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly.
• Makes appropriate contacts in order to acquire or clarify necessary information.
• Compiles and updates the appeal log detailing denials, hospital's reply, and follow-up responses.
• Provides information and responds to inquiries regarding medical documentation and DRG'S to hospital staff including Utilization and Quality Assurance staff, Patient Accounts staff and the Risk Manager.
• Abstracts information from medical records to compile reports and statistical information.
• May train lower level coders and provide technical guidance and expertise
• Resolves bill holds in a timely manner to maintain DNFB and maintains coding queue
• Acts as a liason between Patient Accounting and Coding

Qualifications/Requirements

Experience

Minimum of three years of experience where the primary function of the position must have been inpatient coding in acute care setting.

Demonstrate proficiency

in ICD 10 CM and ICD 10 PCS by passing coding assessment administered before hire.

Education

High School or equivalency diploma, required. Satisfactory completion of 30 credits* toward an Associate’s degree or Bachelor’s degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience. There is no substitution for the two years of specialized experience.

Licenses / Certifications

Current certification as a Certified Coding Specialist (CCS) required. Certification as Registered Health Information Administrator (RHIA) or as a Registered Health Information Technologist (RHIT) by the American Health Information Management Association preferred.

Other

Comprehensive knowledge of the American Hospital Association (AHA) Official Coding Guidelines; comprehensive knowledge of the current and ICD10 CM/PCS codes; thorough knowledge of DRG classification systems; thorough knowledge of medical terminology, anatomy and physicology; ability to understand and code medical records; ability to communicate effectively both verbally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar and e-mail for performing work assignments; ability to read, write, speak, understand, and communicate sufficiently to perform the essential duties of the position.