Incumbent will also be responsible for addressing RAC and related payer denials and reviews. Coding of highly complex medical records as well as medical record review. This class differs from a Level 2 in that addressing review and focused auditing when needed is distinctive; knowledge and skill level is greater. Supervision is not a responsibility of this position, however technical guidance and acting in a mentoring educational role is expected when appropriate. Incumbent must have skill set to: * Addresses appeals and review documentation needed for insurance denials to facilitate expedient resolution and reimbursement. * Participates in mandated Medical Record Review processes. * Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures. * Identifies and analyzes patterns in possible coding errors or other trends to report to Coding Leadership, Coding Leads and/or Coding Auditor. * Ensures that all factors necessary for assigning accurate DRG are present, and that related diagnoses are ranked properly. * Assign accurate present on admission indicators. * Provides information and responds to inquiries regarding medical documentation and DRG's to CDI staff including Utilization and Quality Assurance Departments when needed. * Knowledge of discharge disposition and reimbursement outcomes. To appropriately and accurately translate diagnoses, contact with appropriate charging departments and healthcare providers may be required to acquire or clarify necessary information. Incumbent must be knowledgeable in Anatomy and Physiology of the human body, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed. Job responsibilities include assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided. When documentation is incomplete, vague, or ambiguous, it is the responsibility of incumbent to work in conjunction with department Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable sign, symptom, or diagnosis and/or physician order. Other responsibilities include:
* Adherence to Health Information Management (HIM) Coding policies. * Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy. * Responsibility for maintaining coding certification and referencing current ICD-9/ ICD-10 coding guidelines and regulatory changes. * Participates in performance improvement initiatives as assigned.
This position will also be involved in collaboration and teamwork with Clinical Documentation Improvement Department. The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership. Telecommuting is allowed with approval from HIM Management. KNOWLEDGE, SKILLS & ABILITIES 1. Knowledge of Anatomy and Physiology, Disease Pathology, Pathophysiology, Pharmacology and Medical Terminology. 2. Knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS' Official Guidelines for Coding and Reporting ICD-9-CM/ ICD-10-CM coding. 3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-9-CM/ ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers. 4. Knowledge of clinical content standards. This position does not provide patient care.
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Renown Health
Feb 02, 2025 