CODING SPEC-CLINIC

Overview: Health Information Management Inpatient Coder Specialist Full Time, 80 Hours Per Pay Period, Day Shift Covenant Health Overview: Covenant Health is East Tennessee’s top-performing healthcare network with 10 hospitals and over 85 outpatient and specialty services, and Covenant Medical Group, our area’s fastest-growing physician practice division.
Headquartered in Knoxville, Covenant Health is a community-owned, not-for-profit healthcare system and the area’s largest employer with over 11,000 employees.
Covenant Health is the only healthcare system in East Tennessee to be named six times by Forbes as a Best Employer.
Position Summary: Analyzes the inpatient medical records to obtain information necessary for the appropriate sequencing and assignment of ICD-10-CM and ICD-10-PCS codes.
Confirms appropriate DRG assignment.
Abstracts and enters data from the medical records in order to maintain a database for statistics and reporting.
Recruiter: Kathleen Rice || kkarnes@covhlth.
com || 865-835-3727 Responsibilities: Reviews medical records to determine the ICD-10 CM and ICD-10 PCS codes to be utilized, in accordance with coding and reimbursement guidelines.
Ensure high levels of accuracy in all patient files.
In case of any inaccuracies or discrepancies, then it is his or her responsibility to report the matter to the coding manager so that the necessary corrections and updates can be made.
Verifies data in the medical record abstract and accurately abstracts and enters clinical information from the medical records, to ensure the integrity of the database.
Appropriately utilizes current UHDDS standards in the proper selection and assignment of the principal diagnosis, principal procedure, complications and comorbid conditions.
Follows policies, procedures, and safety standards.
Completes required education assignments annually.
Works toward achieving goals and objectives and participates in quality improvement initiatives as requested.
Increase understanding of APCs, DRGs, case mix, and denials.
Performs other duties as assigned.
Oversees through monitoring and by reviewing and auditing the coding staff to ensure position accountabilities and performance criteria are adhered to.
Develops and maintains departmental and hospital policies and procedures and implements new policies and procedures relative to coding.
Educates and assists physicians and clarifies coding versus clinical issues.
Works closely with Registration and Business Office personnel to resolve issues related to claims, coding, pre-cert, and denials appeals, and verifies that appropriate chargemaster rates are used.
Reviews medical record documentation to ensure existing documentation supports diagnostic/procedure code billed per UB 92 or HCFA 1500 form.
Provides education to coding staff and physicians in response to regulatory changes and identified areas of deficiency.
Monitors claim rejections and systematically assesses specific types of denial as it relates to coding and documentation issues, outpatient registration, and the receipt of physician orders.
Attends meetings and provides input as it relates to coding, medical documentation, and reimbursement issues specific to medical billing and regulatory requirements.
Increases awareness of compliance as it relates to coding and documentation.
Facilitates and coordinates education of coding staff in the areas of coding, documentation, case mix, and denials.
Increases understanding of APCs, DRGs, case mix, and denials.
Educates coding staff to proper documentation necessary to support a DRG/APC/Medical Necessity/ROM/SOI.
13 Integrates documentation, coding, and proper oversight to ensure accurate reimbursement.
Reviews records to verify if the correct code has been assigned.
Assists with all insurance requested audits and provides information to supervisor related to inaccurate and/or missing documentation.
Reviews DRG/APC classifications and educates to maximize level of care assignment for increased reimbursement.
Keeps current on local, state, and federal regulations to ensure compliance.
Keeps current on coding guidelines and communicates to Health Information Manager.
Implements corrective actions as indicated to minimize financial risk.
Works with Denials Elimination Group and deals with physician specific issues as it impacts denials.
Ensures LCDs/NCDs are being adhered to by admissions and hospital personnel to ensure qualifying diagnosis covers tests/procedures.
Analyzes denials and coordinates appeals.
Ensures corrective action is taken to prevent denials from reoccurring.
Follows policies, procedures, and safety standards.
Completes required education assignments annually.
Works toward achieving goals and objectives, and participates in quality improvement initiatives as requested.
Qualifications: Minimum Education: None specified; however, must be sufficient to meet the standards for achievement of the below indicated license and/or certification as required by the issuing authority.
Minimum Experience: Five or more (5+) years coding experience.
Licensure Requirement: RHIA, Coding, or RHIT certification required.
Registered Health Information Technologist preferred.