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Role Description
This expert level inpatient senior coding analyst is responsible for coder training, work queue management, performing second-level coding reviews utilizing auditing software, and documenting findings to improve MCC/CC, HAC/PSI, HCC, and Quality Indicator validation.
- Conducts review and audit of discharged inpatient records (prebill and retrospective reviews) to validate the coding/DRG assignment according to official coding guidelines as supported by the clinical documentation in the record.
- Monitors work queues daily to identify, prioritize, and assign accounts that need to be coded based on department-specific guidelines and within designated timelines in coordination with leadership.
- Mentors and trains coders on application of correct ICD-CD and ICD PCS guidelines.
- Coordinates and identifies provider documentation queries for the Clinical Documentation Integrity team to send to clinical providers.
- Consults, provides professional expertise to, and collaborates with clinical documentation specialists on coding and documentation practices and standards.
- Assists with and develops educational programs for coding staff, clinical documentation staff, and medical staff including yearly coding/DRG updates.
- Applies ICD and ICD-PCS codes including major traumas and Neonatal Intensive Care Unit (NICU) records based on review of clinical documentation.
- Identifies and assists management with the resolution of coding issues, process improvement, and system testing for HIM applications.
- Interacts with other departments to resolve coding issues and assists with coding and clinical validation denials.
- Participates in on-site, remote, and/or external training workshops and training.
- Performs other duties as assigned.
Qualifications
- Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program.
- 4 years of experience in inpatient coding and abstracting with healthcare billing process experience in an acute care setting.
- Demonstrated high coding accuracy and productivity.
Requirements
- Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC) or other approved coding credential.
- Knowledge of electronic medical records and 3M or Encoder System.
- EPIC health information system experience (preferred).
- Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process.
- Knowledge of MS DRG prospective payment system and severity systems.
- Knowledge of Clinical Documentation Improvement principles, quality indicators, formal and informal coding audit process.
- Ability to work effectively, independently and manage multiple demands consistently.
- Proficient computer skills (spreadsheets and database).
- Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability (preferred).
Benefits
- Comprehensive health insurance
- 401(k) with company match
Company Description
Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family.
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