Senior Coder HIM

CommonSpirit Health was formed by the alignment of Catholic Health Initiatives (CHI) and Dignity Health. With more than 700 care sites across the U.S. from clinics and hospitals to home-based care and virtual care services CommonSpirit is accessible to nearly one out of every four U.S. residents. Our world needs compassion like never before. Our communities need caring and our families need protection. With our combined resources CommonSpirit is committed to building healthy communities advocating for those who are poor and vulnerable and innovating how and where healing can happen both inside our hospitals and out in the community.

The Senior Coder (Sr. Coder) acts as a lead coder for their designated team. This position will train staff on department policies, procedures, systems and correct coding requirements. The Sr. Coder additionally will audit Coders, fill in for out-of-office Coders, and make recommendations to Coding Leadership to help improve the efficiency of the team. 

1.1 Employee will comply with all laws, rules, and regulations relating to the position. 

1.2 The employee has a duty to report any suspected violations of the law to his/her immediate supervisor, compliance officer, or CEO. 

1.3 Employee will follow the coding guidelines set by AHIMA (American Health Information Management Association,) NCCI (National Correct Coding Initiative) edits, CMS (Center for Medicare and Medicaid Services,) and the Standards of Coding Ethics. 

1.4 Selects appropriate assignments for coding from assigned work queues. 

1.5 Assigns codes by encounter: 

-Selecting the accurate principal diagnosis and procedure code; 

-Sequencing codes to optimize reimbursement in conformance with policies; 

-Coding only diagnoses and procedures which can be substantiated by documentation with the medical record; -Following coding guidelines; 

-Distinguishing cases which require additional information from physicians and contacting the physician for clarification using either direct contact or the physician query form. 

1.6 Where defined in policy: Verifies charges entered for the encounter match the documentation contained within the record. 

1.7 Routes to department when charges do not agree. 

1.8 Correctly utilizes coding applications & systems to appropriately code and abstract all assigned encounters. 

1.9 Analyzes APCs and Modifier assignment to ensure all data has been considered to ensure accurate and compliant coding and charging. 

1.10 HIM Coders shall use their skills, their knowledge of ICD and CPT rules, guidelines and requirements and any available resources to select appropriate diagnosis and procedural codes. 

1.11 HIM Coders shall not change codes or narrative of codes so that the meanings are misrepresented, nor should diagnosis or procedures be included or excluded because the payment may be affected. Statistical clinical data is an important result of coding and maintaining a quality database shall be a conscientious goal. 

1.12 Physicians will be consulted for clarification when conflicting or ambiguous documentation is noted in the record. 

1.13 The HIM Coder is a member of the healthcare team and, as such, shall assist physicians who are unfamiliar with ICD, CPT or DRG methodology. 

1.14 The HIM Coder is expected to strive for optimal payment to which the facility is legally entitled and will not engage in unethical and illegal practices to maximize payments by means that contradict regulatory guidelines. 

1.15 Reviews unbilled to assure records are all coded within department timeframes. 

1.16 Maintains patient, medical record, department, and employee confidentiality at all times. 

1.17 Consistently demonstrates a positive attitude and fosters teamwork by offering assistance to others as needed.

Responsibilities 

1.18 Effectively uses tools provided to monitor coding backlog and coding errors needing correction. 

1.19 Works with other departments to correct inaccurate clinical or demographic information regardless of the source of the information. 

1.20 Reviews the APC grouper edit and assists in clearing the edits related to coding and compliance. 1.21 Assists with the orientation and training of new employees. 

1.22 Provides input to supervisor regarding coding policies and procedures. 

1.23 Fulfills yearly continuing education requirements of the department and the hospital, to include safety and mandatory in services. Responsible for maintaining credentials. 

1.24 Attends and participates in department or section meetings. 

1.25 Contributes to the overall operation of the department by performing other duties, as assigned. 

• 3 years Coding Experience (Hospital Facility, Professional Fee, Physician Clinic) using ICD and CPT coding and/or knowledge of APC’s, modifiers, and other payment methodologies. Electronic Medical Record (EMR) or Cerner experience.
• Certified as a CCS, CCS-P, CPC, CPC-H, CPC-P, RHIT, RHIA
• Must have and maintain an in-depth knowledge of CPT, ICD, and HCPCS coding guidelines.