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Keck Medicine of USC · 1 day ago

Coder Editor, HIM - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Los Angeles, CA

Full-time

Onsite

Entry Level

$39/hr - $63.95/hr

1+ years exp

Keck Medicine of USC is a healthcare organization seeking a Coder Editor to ensure compliance with federal coding regulations. The role involves analyzing and resolving coding-related edits and accurately coding medical records to facilitate proper billing processes.

Health CareHospitalService IndustryWellness

Responsibilities

Perform ‘denial prevention’ functionalities by researching, editing, & correcting all coding edits and/or coding issues Re: all diagnostic and procedural information from the medical records using OCE/NCCI, CMS Transmittals, MAC Transmittals, Medicare Claims Processing Manuals, ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions

Perform ‘denial management’ functionalities, processes, research, editing, & correction to recover reimbursements previously denied by payers

Reviews the entire medical record; accurately classify and sequence diagnoses and procedures; ensure the capture of all documented conditions that coexist at the time of the encounter/visit, all medical necessity diagnoses, complications, co-morbidities, historical condition or family history that has an impact on current care or influences treatment, and all external causes of morbidity

Enter patient information into inpatient and outpatient medical record databases (ClinTrac/HDM). Ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements prior to billing interface and claims submission

Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes

Attendance, punctuality, and professionalism in all HIM Coding and work related activities

Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions. Completes tasks accurately, legibly, and in a timely fashion

Ability to achieve a minimum of 95% editing/coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s)

Ability to achieve a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s)

Assist in ensuring that all medical records contain medical necessity information required for optimal and accurate coding and abstracting

Recognizes education needs of based on monthly reviews and conducts self-improvement activities

Ability to act as a resource to coding and hospital staff on coding issues and questions

Ability to improve MS-DRG assignments specific to CDI documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions

Ability to improve APR-DRG, SOI, and ROM assignments specific to CDI documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions

Ability to improve APC/HCC assignments based on medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions

Maintains at minimum, expected productivity standards (See HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort

Works coding queues/task lists to ensure 95% of patient bills are dropped within 5 days after patient discharge/date of service

Works coding queues/task lists to ensures the remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service

Assist other coders in performance of duties including answering questions and providing guidance, as necessary

Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and/or providing information so that an interim bill can be generated. Assists with physicians, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed

Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority

Maintains AHIMA and or AAPC coding credential(s) specified in the job description

Attend coding & CDI seminars, webinars, and in-services to maintain the required annual continued education units (CEU)

Keep up-to-date and reviews ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, and CPT Assistant to maintain knowledge of the principles of coding

Keep up-to-date and reviews other professional journals and newsletters in a timely fashion to maintain knowledge of the principles of coding

Consistently attend and actively participate in the daily huddles

Consistently adhere to HIM policies and procedures as directed by HIM management

Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed

Participates in continuously assessing and improving departmental performance

Ability to communicate changes to improve processes to the director, as needed

Assists in department and section quality improvement activities and processes (i.e. Performance Improvement)

Works and communicates in a positive manner with management and supervisory staff, medical staff, co-workers and other healthcare personnel

Ability to communicate effectively intra-departmentally and inter-departmentally

Ability to communicate effectively with external customers

Provides timely follow-up with both written and verbal requests for information, including voice mail and email

Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage

Working knowledge, efficient navigation, & full use of 3M-CRS Encoder system; utilize to expedite coding process; utilize all references

Knowledge & understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac

Working knowledge, efficient navigation, & full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software

Working knowledge, efficient navigation, & full use of ‘3M 360 Encompass/CAC’

Performs other duties as assigned

Qualification

ICD-10-CM codingCPT codingHCPCS coding3M-CRS EncoderMedical TerminologyDenial managementCoding complianceCoding accuracyCustomer serviceFire Life Safety TrainingEHR navigationCoding software proficiencyCoding guidelines knowledgeOrganization skillsTeamworkCommunication skillsTime management

Required

High school or equivalent

Specialized/technical training College courses in Medical Terminology, Anatomy & Physiology and a certified coding course. Successful completion of the hospital specific Coding Test – with a passing score of ≥70%. The coding test may be waived for former USC or agency/contract HIM Coding Department Coders who historically/previously met the ≥ 90% internal/external audit standards of the previously held USC Job Code

1 year Experience in ICD-9 & ICD-10 (combined) and CPT/HCPCS coding of ambulatory surgery medical records in hospital or outpatient surgical center, and experience in using a computerized coding & abstracting database software and an encoding/code-finder systems

Knowledge of medical terminology

Organization/time management skills

Demonstrate excellent customer service behavior

Able to function independently and as a member of a team

Working knowledge of CPT, HCPCs and ICD9 coding principles

Certified Coding Specialist - CCS (AHIMA) OR AHIMA Certified Coding Specialist - Physician (CCS-P); OR AAPC Certified Professional Coder (CPC); OR AAPC Certified Outpatient Coding (COC) If there is the absence of a national coding certificate and the coder possesses any one of the following national certifications, the coder will be required to pass any of the national coding examinations Re: the aforementioned coding certificates within six (6) months of employment: 1. AHIMA Registered Health Information Technician (RHIT) 2. AHIMA Registered Health Information Administrator (RHIA)

Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)