Health Insurance Coder jobs

Your Role The Medical Coder-Inpatient DRG (IPDRG) provides high-level technical competency and subject matter expertise in analyzing physician/provider documentation in Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Medicare Severity Diagnosis-Related Groups (MS-DRG), All Patient Refined DRGs (APR), Present on Admission (POA), as well as Severity of Illness (SOI) & Risk of Mortality (ROM) indicators for Inpatient records. Identifies Hospital Acquired Conditions (HAC) and Patient Safety Indicators (PSI) to ensure accurate hospital reimbursement. As a Medical Coder - Inpatient, you will:

Documentation Review and Code Assignment

● Assign appropriate code(s) by utilizing coding guidelines established by:

● The Centers for Disease Control (CDC), ICD-CM Official Coding Guidelines for Coding and Reporting, Centers for Medicare/Medicaid Services (CMS) ICD-PCS Official Guidelines for Coding and Reporting

● American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification

● American Health Information Management Association (AHIMA) Standards of Ethical Coding

● Revenue Excellence/HM coding procedures and guidelines

● Navigate the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs, APR DRGs, and identify HACs and PSIs or other indicators that could impact quality data and hospital reimbursement.

● Code Inpatient health records utilizing encoder software and consistently uses online tools to support the coding process and references to assign ICD codes, MS-DRG, APR DRGs, POA, SOI & ROM indicators.

● Review Inpatient health record documentation, as part of the coding process, to assess the presence of clinical evidence/indicators to support diagnosis code and MS-DRG, APR DRG assignments to potentially decrease denials.

● Work on inpatient claim edits and may code consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.

● Adhere to the Inpatient coding quality and productivity standards established by the organization.

● Safeguard patient health information in compliance with HIPAA standards. Query Management & Follow-Up

● Demonstrate knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS), or other healthcare providers when additional information is needed for coding and/or to clarify conflicting or ambiguous documentation.

● Utilize EMR communication tools to track missing documentation or Inpatient queries that require follow-up to facilitate coding in a timely fashion.

HIM Collaboration

● Work with HIM and Patient Financial Services (PFS) teams, when needed, to help resolve billing, claims, denial, and appeals issues affecting reimbursement. Coding Knowledge & Expertise

● Maintain CEUs as appropriate for coding credentials as required by credentialing associations.

● Maintain current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations, as well as new applications or settings for Inpatient coding, e.g., Hospital at Home.

● Identify and report coding and/or EMR workflow issues to their supervisor.

● Exhibit awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance and resolution when appropriate.

● Maintain a working knowledge of applicable coding and reimbursement Federal, State, and local laws and regulations, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical, and professional behavior.

● Perform abstracting of additional data elements.

NOTE: 4-6 MONTHS ONSITE TRAINING

Pay: Php100,000.00 - Php120,000.00 per month

Work Location: Remote