The coding function is a primary source for data and information used in health care and promotes provider/patient continuity, accurate database information, and the ability for SWH clients to receive appropriate reimbursement. The coding function also ensures compliance with established coding guidelines, third-party reimbursement policies, regulations and accreditation guidelines.
The Shearwater Health (SWH) Medical Coder performs technical and specialized data analytic functions for SWH's acute care hospitals and for other clients including those who manage payment policy for payers. The employee abstracts clinical information from health records and assigns accurate and complete ICD-10-CM, CPT-4 codes and other medical codes and DRG Assignments as needed in accordance with Official Coding Guidelines and SWH client guidelines as appropriate. The employee reviews facility health records for accuracy and completeness of coding and DRG assignment. On occasion, the employee may code for purposes other than traditional patient billing and provide services in support of coding such as coding and payment policy research.
ESSENTIAL FUNCTIONS (time allocations estimated)
EDUCATION AND EXPERIENCE:
SWH requires a BS in Nursing and PRC licensed, ideally in a clinical area of practice and/or previous experience as a medical coder. Previous coding experience will ideally consist of two (2) years of coding experience using ICD-10-CM or equivalency with a focus on inpatient coding. The employee must have an excellent command of medical terminology, anatomy and physiology, and United States health record content. Fluency coding in multiple types of records: inpatient, outpatient (ER, diagnostic, injections/infusions or observation) and ambulatory surgery is desired at the time of hire or will be required after completion of training. Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or other AHIMA or AAPC approved coding credential is desired within six months of hire. The employee is expected to enroll in continuing education courses to maintain certification as approved by SWH.
COMPLEXITY OF DUTIES:
Duties are highly complex, varied, require planning and coordinating several activities at one time, and demand the use of problem-solving skills and analysis of circumstances to develop appropriate actions.
RESPONSIBILITY FOR ACCURACY:
Review of work and subsequent procedures will detect the most significant errors of job functions. However, more serious errors could result in inefficient operations and loss of revenue. Because the information in the health record is the basis for reimbursement as well as clinical decision-making, coding entries must be complete and accurate. The amount of reimbursement depends on the correct coding of diagnoses and procedures and appropriate DRG/APC assignment. The work has a direct effect on medical record keeping and a direct impact on the accuracy, documentation, timeliness, reliability and acceptability of information in the medical record services. SWH expects all Medical Coders to meet or exceed 95% accuracy as measured by externally engaged quality assurance coding companies.
High levels of mental concentration are required. Must handle multiple tasks simultaneously and is subject to interruptions. The physical effort requires sitting and reaching with hands and arms. Manual dexterity, visual acuity, and the ability to communicate in English are required. Work is performed in a normal business office environment, most often on the night shift however some work may be scheduled during the daytime.
While inpatient coding is the primary focus of the position, other coding assignments will develop from time to time. SWH expects competent inpatient coders to produce no less than three (3) charts per hour at a 96% or higher accuracy rate as measured bases on quality assurance audits. Coders scoring under 96% accuracy will be placed on a performance improvement plan and failure to improve may be grounds for dismissal.
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