CODER III

Department: UNMHSC HS-Coding
FTE: 1.00
Full Time
Shift: Days

Position Summary:
Code inpatient hospital discharge and outpatient accounts for the purpose of reimbursement, research and compliance with federal regulation according to diagnosis, operation, and procedure using the current ICD, CPT and DRG coding classification systems. Perform second level coding audits for accuracy of accounts coded by Coder I and/or Coder II positions to ensure coding compliance and accuracy for high profile accounts such as HACs, mortality, payer DRG audits, Coder/CDI DRG mismatches, and other quality performance measures. Coordinate and facilitate communication between HIM CDI staff and HIM coding staff to complete provider queries to ensure appropriate and complete provider follow up and documentation. Facilitate teamwork between HIM CDI and coding staff for a cooperative learning environment to arrive at the appropriate working DRG and final DRG for reimbursement. Ensure adherence to Hospital and Departmental Policies and Procedures. No patient care assignment.

Detailed responsibilities:
* CODE - Identify and assign preliminary codes for hospital discharge records and outpatient records for the purpose of reimbursement, research and compliance with federal regulations according to diagnosis(es), operation(s), and procedure(s) using the current version of ICD, CPT, and DRG classification systems
* RESEARCH - Research compliance with federal regulations according to diagnosis, operation, and procedure using the current version ICD, CPT, and DRG classification systems
* CODE - Abstracts statistical data for discharge records using hospital's abstracting system
* CODE - Performs data entry for determining correct DRG
* COMPLIANCE - Identify the need to clarify documentation in medical records and initiate communication with physician, nurse, or patient care coordinator by utilizing the appropriate query tools in order to capture the documentation in the medical record that accurately supports the patient’s severity of illness, risk of mortality, and/or appropriate DRG
* ABSTRACTS - Utilize monitoring tools to track the progress of the Documentation Improvement Program and identified quality indicator tracking elements, interpret tracking information and report findings to Coding Management, HIM Executive Director, Quality Management, Utilization Review/Case Management and UNMH providers as requested
* COMMUNICATION - Communicate with physicians to obtain/clarify specific principal diagnoses or comorbidities and complications; request clarification of existing documentation. Facilitate assertive, tactful, and cooperative communication skills when encountering resistance due to perception that information is adequately documented. Assist with development of CDI standard Query templates. Attend department meetings with CDI staff, and participate in providing CDI tools to medical specialties and appropriate provider documentation of clinical activities
* COORDINATION - Coordinate and facilitate communication between Health Information Management, Utilization Review/Case Management, Quality Management, Physician Leadership (i.e. Executive Medical Director for Patient Safety & Quality, UR physicians, etc.) as needed to acquire, interpret, and transmit accurate diagnostic and procedure documentation. Keep Coding Management and Executive Director HIM informed of potential and/or actual problems identified during the review process and operations of the program
* REPORTS - Compile and assist in the communication and distribution of physician profiling reports provided in conjunction with the Coding and Clinical Documentation Improvement Programs
* RELATED WORK - Perform related duties and responsibilities as required
* AUDIT - Develop, oversee and conduct various routine and special audits, research and correct data to maintain integrity of programs
* QUERY - Identify and complete appropriate queries to providers when more specific or clarifying documentaion is needed to accurately code IP discharges. Maintian department query statndards and expectations as outlined in department policies and procedures

Qualifications

Education:
Essential:
* High School or GED Equivalent
Nonessential:
* Associate Degree
Education specialization:
Nonessential:
* Related Discipline

Experience:
Essential:
2 years directly related experience

Nonessential:
3 years directly related experience

Credentials:
Essential:
* Department Approved Cert - See Job Description

Physical Conditions:
Sedentary Work: Exerting up to 10 pounds of force occasionally (Occasionally: activity or condition exists up to 1/3 of the time) and/or a negligible amount of force frequently (Frequently: activity or condition exists from 1/3 to 2/3 of the time) to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

Working conditions:
Essential:
* No or min hazard, physical risk, office environment