HIM Specialty Coder II at Billings Clinic in Billings, Montana

Job Description:

This position may be eligible for a $5000 sign-on bonus, relocation assistance, and tuition loan repayment


The HIM Specialty Coder II is responsible for accurately reviewing, coding, and abstracting patient medical records to ensure the proper coding of diagnoses, procedures, and services for billing and reimbursement purposes. The role demands advanced knowledge in coding and reimbursement methodologies, a deep understanding of compliance regulations, and the ability to manage complex coding scenarios across multiple specialties. This position is critical to safeguarding the financial integrity of Billings Clinic by ensuring adherence to coding standards and maximizing appropriate reimbursement.


Essential Job Functions


• GENERAL:
Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Coding and Documentation:
Review and analyze medical records to identify the principal diagnosis, procedures, and any applicable secondary diagnoses and procedures.
Use reference tools, including ICD-10 and CPT -4 books, to assign appropriate ICD-CM, ICD-PCS, and/or CPT-4/HCPCS codes for each encounter.
Utilize computerized encoding systems and coding books to facilitate accurate coding and sequencing of diagnoses and procedures, adhering to all regulatory compliance policies and procedures.
Calculate DRGs or APCs for inpatient visits/encounters and/or physician services coding, ensuring that coding optimizes reimbursement ethically and in compliance with approved guidelines.
Assign POA (Present on Admission) indicators for inpatient facility coding and capture any missing charges.
• Compliance and Quality Assurance:
Ensure data accuracy prior to billing interface and claims submission, including discharge disposition, appropriate use of modifiers, CPT, ICD, performing provider, date of service, POA, NCCI, and other coding and abstracting requirements.
Meet and maintain established productivity and quality standards for assigned coding areas.
Identify and report any regulatory or compliance concerns to the Manager, Director, or Billings Clinic Corporate Compliance Department.
Participate in process improvement initiatives and ensure adherence to all applicable Billings Clinic and regulatory compliance policies and procedures.
• Cross-Training and Specialty Assignments:
Clinic: Perform diagnosis, E/M, and procedure coding across multiple specialties within the physician clinic. Participate in training on reimbursement functions and may begin auditing clinic encounters.
Hospital: Perform coding for all outpatient services and outpatient surgery. Begin training in inpatient coding to expand expertise.
• Leadership and Mentorship:
Serve as a resource to Level I staff, responding to procedural questions and assisting with problem resolution.
Apply and adhere to coding practices, guidelines, and standards to assist the management team in maintaining high-quality coding functions.
Train and mentor specialty coders in assigned areas, providing backup support to other areas of the Coding Resources department as needed.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.


Minimum Qualifications


Education


• Minimum High School or GED High school graduate or equivalent
• Prior formal training in Anatomy, Medical Terminology and Coding


Experience


• Clinic: At least two (2) years of experience in coding within a physician clinic, handling multiple specialties and possessing basic reimbursement experience.
• Hospital: At least two (2) years of experience in hospital coding, covering all patient types and managing coding for third-party and government payers.


Certifications and Licenses


• Credentialed as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), or holding other AHIMA and/or AAPC recognized coding credentials.
• Obtaining specialty certification (e.g., CCS, RCC, ROCC) in addition to core coding credentials is encouraged to deepen expertise in areas like Interventional Radiology, Radiation Oncology, or Cardiac Cath Lab coding.
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.