Coder – Inpatient DRG Coding

Coder – Inpatient DRG Coding

Requirements

• High School Diploma or Equivalent (GED) – (Required)
• Graduate from Specialty Training Program – (Preferred)
• Minimum of 1 year – Related work experience (Required)
• Certified Professional Coder – American Academy of Professional Coders (AAPC)
• Certified Risk Adjustment Coder – American Academy of Professional Coders (AAPC)
• Registered Health Information Technician (RHIT) – American Health Information Management Association
• Internet requirements: Cable modem, (high speed, only – No DSL or Wireless Cellular Service or Satellite Service) The minimum requirement is: 25 MBPS UP, 75 MBPS DOWN, <150 ms Ping Required, <30ms Jitter Required
• Computer must be connected to the internet via Ethernet cable; wifi is not permitted unless a Virtual Private Network (VPN) is used for the wifi connection.

Responsibilities

• Reviews the content of the medical record for hospital and professional inpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply with standard provider coding regulations.
• Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses and procedures are recorded.
• Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes as required.
• Using the Encoder software program, determines the codes for all diagnoses and procedures.
• Determines their sequencing to legally maximize reimbursement.
• Assigns the appropriate DRG.
• Assigns codes based on hospital and professional coding guidelines, Coding Clinic directives, federal regulations, CCI coding initiatives, CPT Assistant or other standard coding guidelines.
• Queries physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding.
• Understands and applies internal policy and procedure guidelines regarding how to phrase physician queries.
• Assists the Coding Quality and Professional Manager with training of new coding staff related to hospital and professional coding guidelines, encoder and other software systems needed for the coding process, along with reviewing coding guidelines on an annual basis and makes recommendations for change to improve coding and data management.
• Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies, etc. documented within patient records to ensure that appropriate diagnosis and procedure codes are selected and incorporated into hospital and professional coding guidelines.
• Updates and corrects historical file data by completing and submitting claim action reports per the PHC4 quarterly report.

Preferred Qualifications

• PCS procedural coding experience preferred
• DRG coding, familiarity of MDCs and knowledge /experience with ICD10-PCS