Inpatient Coder II, HB coding

The Inpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.

The Inpatient Coder II is the coding and reimbursement expert for ICD-10-CM diagnosis coding and ICD-10-PCS procedure coding for complex inpatient acute care discharges. Possesses a strong foundation in coding conventions, instructions, Official Guidelines for Coding and Reporting and Coding Clinics. Has a deep understanding of disease process, anatomy/physiology, pharmacology and medical terminology.

RESPONSIBILITIES:

* Utilizes technical coding expertise to assign appropriate ICD-10-CM and ICD-10-PCS codes to complex inpatient visit types. Complexity is measured by a Case Mix Index (CMI) and Coder II’s typically see average CMI’s of 2.2609. This index score demonstrates higher patient complexity and acuity.

* Utilizes expertise in clinical disease process and documentation, to assign Present on Admission (POA) values to all secondary diagnoses for quality metrics and reporting.

* Thoroughly reviews the provider notes within the health record and the Findings from the Clinical Documentation Nurse in the Clinical Documentation Improvement (CDI) Department who concurrently reviewed the record and provide their clinical insight on the diagnoses.

* Utilizes resources within CAC (Computerized Assisted Coding) software to efficiently review documentation and select or assign ICD-10-CM/PCS codes using autosuggestion or annotation features.

* Reviews Discharge Planning and nursing documentation to validate and correct when necessary, the Discharge Disposition which impacts reimbursement under Medicare’s Post-Acute Transfer Policy.

* Utilizes knowledge of MS-DRG’s, APR-DRG’s, AHRQ Elixhauser risk adjustment to sequence the appropriate ICD-10-CM codes within the top 24 fields to ensure correct reimbursement and NM’s ranking in US News and World Report.

* Collaborate with CDI on approximately 45% of discharges regarding the final MS or APR DRG and comorbidity diagnoses.

* Educates CDI on regulatory guidelines, Coding Clinics and conventions to report appropriate ICD-10-CM diagnoses.

* Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, medical terminology to determine the Principal Diagnosis, secondary diagnoses and procedures.

* Follows the ICD-10-CM Official Guidelines for Coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, Coding Clinic for ICD-10-CM and ICD-10-PCS, coding conventions and instructional notes to assign the appropriate diagnoses and procedures.

* Utilizes coding expertise and knowledge to write appeal letters in response to payor DRG downgrade notices.

* Resolves Nosology Messages/Alerts and Coding Validation Warning/Errors.

* Meets established coding productivity and quality standards.