Health Information Coding Analyst

Regions is hiring a Health Information Coding Analyst. As a coding analyst, you will support multiple sites and actively participate within a team who performs a wide variety of complex coding scenarios to ensure accurate assignment of ICD-10 and CPT Codes. This position completes coding analysis of each individual patient stay. It provides accurate diagnoses, procedures and other relevant data base information for optimal financial reimbursement, collection of unique and pertinent information and accumulation of statistical data; and perform related duties as assigned. Some components of the major job duties and tasks may not pertain to your position, some are inpatient coding specific, and some are outpatient coding specific. If you have questions on what pertains to your position, contact your leader.

MINIMUM QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

  • Graduate from an associate or bachelor’s degree program in health information, completion of a coding specialist program or successful completion of AHIMA or AAPC coding credential exam.

  • 3-5 years’ experience in ICD-10/CPT coding

• Licensure/ Registration/ Certification:

  • CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS-D (Homecare Coding Specialist-Diagnosis), HCS-H (Home Care Coding Specialist-Hospice), CEDC (Certified Emergency Department Coder), CCS-P (Certified Coding Specialist-Physician based), RHIT (registered health information technician), or RHIA (registered health information administrator).

• Knowledge, Skills, and Abilities:

  • Knowledge in using CPT-4, ICD-10 CM/PCS coding guidelines, rules and regulations

  • Knowledge of anatomy and physiology

  • Knowledge of basic disease processes

  • Knowledge of medical terminology

  • Intermediate computer skills required

  • Ability to communicate information in a professional, confident, and confidential manner.

PREFERRED QUALIFICATIONS:

• Education, Experience or Equivalent Combination:

  • Graduate from an associate or bachelor’s degree program in health information or completion of a coding specialist program.

  • 5+ years’ experience in ICD-10/CPT coding

• Licensure/ Registration/ Certification:

  • CCA (Certified Coding Associate), CIC (Certified Inpatient Coder), COC (Certified Outpatient Coder), CCS (Certified Coding Specialist), CPC (Certified Professional Coder), HCS (Homecare Coding Specialist), CEDC (Certified Emergency Department Coder), CCS-P (Certified Coding Specialist-Physician based), RHIT (registered health information technician), or RHIA (registered health information administrator)

• Knowledge, Skills, and Abilities:

  • Demonstrates a thorough understanding of the front and back-end revenue cycle components in a physician and hospital setting.

ESSENTIAL DUTIES:

1. (70%) – Health Information Documentation

   1. Select the diagnoses and procedures that require coding according to current coding and reporting requirements for acute care services for inpatient and outpatient

   2. Reviews appropriate provider documentation to determine principal diagnosis, co-morbidities and complications, secondary conditions and surgical procedures; writing and sending queries as necessary.

   3. Interpret conventions, formats, instructional notations, tables, and definitions of the classification system to select diagnoses, conditions, problems or other reasons for the encounter that require coding.

   4. Interpret conventions, formats, instructional notations, and definitions of the classification system and/or nomenclature to select procedures/services that require coding.

   5. Sequence diagnoses, reasons for encounter, and procedures according to notations and conventions of the classification system/nomenclature and standard data set definitions (such as Uniform Hospital Discharge Data Set (UHDDS)

   6. Utilizes technical coding principals and MS-DRG reimbursement expertise to assign appropriate ICD-10-CM diagnosis and procedures for inpatient encounters

   7. Assigns present on admission (POA) value for inpatient diagnoses

   8. Extracts required information from source documentation and enters into encoder abstracting system

   9. Identifies non-payment conditions (HAC) and when required, report through established procedures

   10. Reviews documentation to verify and, when necessary, correct the patient disposition upon discharge

   11. Apply the official ICD-10-CM/PCS coding guidelines.

   12. Apply the official CPT/HCPCS Level II coding guidelines.

   13. Adheres to all compliance guidelines, both internal and external

   14. Demonstrates ability to meet or exceed departmental quality and productivity standards.

   15. Works closely with clinical documentation improvement specialist and assists them with understanding coding principals and rules as applicable.

   16. Participates in continuing education programs to maintain an understanding of anatomy physiology, medical terminology, disease processes to support the effective application of coding guidelines.

   17. Enhances professional growth and development through participation in professional organizations, coding round tables, literature reviews, and relevant workshops.

   18. Assists in training of new employees

   19. Attend coding department meetings as scheduled.

   20. Performs other duties as assigned

2. (5%) – Regulatory guidelines and reporting requirements for acute care (inpatient) service

   1. Select the principal diagnosis, principal procedure, complications, comorbid conditions, other diagnoses and procedures that require coding according to the UHDDS definitions and coding clinic for ICD-10-CM and ICD-10-PCS

   2. Evaluate the impact of code selection on diagnosis related group (DRG) assignment

   3. Verify DRG assignment based on inpatient prospective payment system (IPPS) definitions

   4. Assign the appropriate admission source and discharge disposition

   5. Works with Team Leads to resolve coding denials

3. (5%) – Regulatory guidelines and reporting requirements for outpatient services

   1. Select the reasons for encounter, pertinent secondary conditions, primary procedure, and other procedures that require coding according to UHDDS definitions, CPT assistant, coding clinics for ICD-10-CM, ICD-10-PCS and HCPCS. This is accomplished through 100% chart abstraction.

   2. Apply outpatient prospective payment system (OPPS) reporting requirements:

      1. Modifiers

      2. CPT/HCPCS Level II

      3. Medical necessity

   3. Review nurse and provider documentation for facility leveling, procedure, IV & Infusion, ICD 10 codes for Emergency Room Facility charges. This is accomplished through 100% chart abstraction.

   4. Review and abstract provider documentation for Staff MD alone, Teaching and Shared services. Abstract provider E&M levels, procedure and ICD 10 codes. This is accomplished through 100% chart abstraction

   5. Works with Team leads to resolve claim edits and coding denials

4. (5%) – Data quality and management

   1. Assess the quality of coded data

   2. Educate health care providers regarding reimbursement methodologies, documentation rules and regulations related to coding

   3. Analyze health record documentation for quality and completeness of coding

   4. Review the accuracy of abstracted data elements for data base integrity

   5. Review and resolve coding edits (such as correct coding initiatives (CCI), Medicare code editor (MCE) and outpatient code editor (OCE).

5. (5%) – Information and communication technologies

   1. Use common software applications (e.g. word processing, spreadsheets, email, etc) in the execution of work processes

   2. Use specialized software in the completion of the coding processes

6. (5%) – Privacy, confidentiality, legal and ethical issues

   1. Apply policies and procedures for access and disclosure of personal health information

   2. Apply AHIMA Code of Ethics/Standards of Ethical Coding

   3. Recognize/report privacy issues/problems

   4. Protect data integrity and validity using software or hardware technology

7. (5%) – Compliance

   1. Evaluate the accuracy and completeness of the patient record as defined by organizational policy and external regulations and standards

   2. Recognize/report compliance concerns/findings

*Job description rankings/percentages are intended to reflect normal averages over an extended period of time, and are subject to daily variances. Quality and efficiency standards should at no time be compromised to meet the average expectations expressed above. Job descriptions are subject to change to accommodate organization or department needs.