Job Description:

Tomah Memorial Hospital

EOE

POSITION DETAILS

Full-time with benefits; 80 hours per two week pay period, Monday through Friday day shift, 8am to 4:30pm; holiday rotation required.

JOB SUMMARY

The Inpatient Coding Specialist II is responsible for coding outpatient and inpatient medical records using Evaluation and Management (E&M), Current Procedural Termination (CPT) and ICD (International Classification of Diseases) 10-CM codes as well as performing deficiency analysis procedures. The Coding Specialist II will be required to work with billing and coding staff to ensure the accuracy of coding and charges on each account. The Coding Specialist II provides personalized and general documentation and coding education to providers and other coders based off industry standards and individual outcomes. Assists in developing, implementing, and maintaining an effective audit and education program for coding consistent with regulatory, professional standards, and healthcare revenue cycle industry practices and other duties as assigned. The Coding Specialist II is also responsible for orientation and training the Coding Specialist role to the department.

MAJOR JOB FUNCTION

Coding/Charge Review and Correction:

1. Responsible for using E&M, ICD-10-CM, ICD-10 procedure codes and CPT according to the following productivity standards which are measured in minutes per account: Inpatient 1 hr 15 min; Observation 37 min; Palliative 25 min; Emergency Room 10 min; Urgent Care 4 min; Warrens Clinic 2 min; Specialty Clinic 7 min; Sleep Lab 4 min; Infusion Services 5 min; Rehab Services 2 min; Imaging 2.5 min; Lab 2 min; Outpatient Surgery (specifically EGD’s, colonoscopies and cataracts) 10 min and Outpatient Surgery 30 min.
2. Resolves National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), along with all coding edits in the electronic record.
3. Reviews and completes accounts in billing and coding work ques on a daily basis, working oldest accounts first.
4. Responsible for completing daily deficiency analysis – including working with providers to obtain signatures or other missing pieces of the medical record for record completion.
5. Remains current with coding and billing changes using available resources (i.e. CPT Assist, Coding Clinic, RWHC Coding Roundtable, American Health Information Association (AHIMA), CorroHealth, MLN matters, etc.)
6. Identifies problem areas in billing operation, proposes and directs solutions.
7. Submits help desk tickets to improve electronic health record documentation and charging tools to ensure compliance with reimbursement and reporting guidelines.
8. Responsible for work ques that affect multiple coders. Will review and disseminate work as appropriate.
9. Assists Coding Specialists and Patient Financial Services Department in identifying patterns, trends, and variations in coding and documentation practices; assists in evaluation of root cause; takes appropriate steps in collaboration with appropriate department to affect resolution or explanation of variances.

Auditing/Education:

1. Provides education to facility healthcare professionals in use of coding guidelines, practices and proper documentation techniques as requested by HIS Director.
2. May be requested to work with Clinical Documentation Improvement Specialist to educate physicians regarding improvements in documentation to meet established requirements, coding/reimbursement and quality of care issues.
3. Audits Medical Coding Specialists work, during orientation and training for accuracy and productivity and reports to Coding Lead and Health Information Services Director.
4. Serves as a resource and subject matter expert to other coding staff.
5. May develop and/or recommend department education plans for process improvements.

Customer Relations/Communications:

1. Maintains confidentiality, is courteous to all customers, addresses and follows up on all customer concerns.
2. Collaborates and communicates with other areas of the department in matters of mutual concern.
3. Participates in a variety of communication medium to stay abreast of current issues within the department and hospital.

Teamwork:

1. Responsible to orient, train, and mentor new coding staff, as assigned.
2. Participates in staff meetings, appropriate in-services and competency testing, as requested.
3. Responsible to complete essential daily tasks of co-workers in their absence.

Miscellaneous:

1. Completes reports as required by the Health Information Services Department.
2. Operates and performs necessary maintenance on equipment. Reports any problems or malfunctions to the Help Desk and supervisor promptly.
3. Performs all other duties as assigned.

STANDARDS OF BEHAVIOR

1. WORK ETHICS STANDARD: Affirm a commitment to making the Tomah Health work environment better through: patient advocacy, continuing education, and valuation of each individual person.
2. COMMUNICATION STANDARD: Affirm a commitment to use open and honest communication with all Tomah Health customers (in-house & community-wide) through: basic customer courtesy (phone, written, face to face) and active listening.
3. TEAMWORK STANDARD: Affirm a commitment to be a proud, dependable Tomah Health TEAM member through: basic customer courtesy, patient advocacy, flexibility, and valuation of each individual person.
4. QUALITY STANDARD: Affirm a commitment to provide respectful, compassionate, quality care with integrity to all Tomah Health customers (in-house & community-wide) through: job excellence, patient advocacy, and self-dignity.
5. PROFESSIONALISM STANDARD: Affirm a commitment to professional conduct towards all Tomah Health customers (in-house & community-wide) through: collaboration, teamwork, appearance, environment, and valuation of each individual person.
6. ATTITUDE STANDARD: Affirm a commitment to maintain a positive, professional perspective towards all Tomah Health customers (in-house & community-wide) through: honest feedback, confidentiality, basic customer courtesy, and valuation of each individual person.
7. Adheres to strict customer confidentiality standards, recognizing that even acknowledgment of privileged information is prohibited.
8. Supports and complies with the National Patient Safety Goals and quality improvement initiatives.

EDUCATIONAL REQUIREMENTS

1. High school diploma or equivalent.
2. Associates Degree in Health Information Technology or related field, coding certificate, or equivalent experience.
3. American Health Information Association (AHIMA) certified Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA) –will be required within one year of start date of employment.
4. Three years of professional or hospital coding experience required.
5. Extensive background in medical terminology, basic anatomy and physiology, surgical terminology and pharmacology and disease processes.
6. Knowledge of insurance billing and collection procedures, including CPT and ICD-10.

QUALIFICATIONS/SKILL

1. Excellent verbal and written communication skills.
2. Excellent human relation skills as demonstrated by the ability to interface positively with all employees.
3. Must have the ability to work with frequent interruptions, under stress and deadlines, with minimal supervision, and to exercise initiative and judgment in analyzing, organizing, planning, prioritizing, scheduling and coordinating work with others.
4. Personal computer and spreadsheet experience required. Microsoft Office experience helpful.
5. Manual dexterity required for computer use. Also needs the ability to stay at one workstation for long periods of time.
6. Proficiency in ICD-10-CM, E&M, and CPT coding.

PI255247770

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