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Advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, CPT IV codes, as well as assignment of the Medicare Severity Diagnosis Related Group, (MS-DRG) / All Patient Refined - Diagnosis Related Group, (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association, (AHIMA) Coding Ethics, as well as all American Hospital Association, (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications. Utilizes 3M 360 in accordance with established workflow. Follows Ensemble policies and procedures and maintains required quality and productivity standards.

Essential Job Functions

• Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group, (MS-DRG) or All Patient Refined Diagnosis Related Group, (APR-DRG.) The Inpatient Coding Specialist is responsible for verification of the patient's discharge disposition and to ensure the appropriate present on admission, (POA) indicators are assigned to each code. The assigned codes must support the reason for the visit that is documented by the provider in order to support the care provided.
• Correctly abstract required data per facility specifications.
• Responsible to assist with writing appeals for Diagnosis Related Group, (DRG) denials in order to support the assigned Diagnosis Related Group, (DRG) and to address the clinical documentation utilized in the decision making process to support the validity of the assigned codes.
• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and epremis, and as a team, ensure timely, compliant processing of inpatient accounts through the billing system.
• Collaborates with Clinical Documentation Specialists, (CDEs,) and members of the medical staff to ensure completeness of documentation in the charts so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
• Responsible to ensure accuracy and maintain established quality, productivity standards, and key performance indicators established for 3M 360 CAC for CRS and Direct Code.
• Remain abreast of current Centers for Medicare and Medicaid Services, (CMS) requirements as well as Correct Coding Initiative, (CCI) edits, Hospital Acquired Conditions, (HAC's) and when applicable, National Coverage Determinations, (NCDs) and Local Coverage Determinations, (LCDs,) including the addition of appropriate modifiers to ensure a clean claim the first time through.
• Maintains competency and accuracy while utlizing tools of the trade, such as the 3M encoder, Computer Assisted Coding, (CAC,) Clinical Documentation Improvement System, (CDIS,) and abstracting systems, and all reference materials. Reports inaccuracies found in software applications to HIM Coding Manager/Supervisor, reports any potential unethical and/or fradulent activity per compliance policy.
• This document is not an exhaustive list of all responsibilities, skills, duties, requirements, or working conditions associated with the job. Associates may be required to perform other job related duties as required by their supervisor, subject to reasonable accommodation

Required Licensure:

RHIA, RHIT, CCS, CIC, or CCA

Mercy Health is an equal opportunity employer.

As a Mercy Health associate, you’re part of a Misson that matters. We support your well-being – personally and professionally. Our benefits are built to grow with you and meet your unique needs, every step of the way. 

What we offer
•    Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
•    Medical, dental, vision, prescription coverage, HAS/FSA options, life insurance, mental health resources and discounts
•    Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
•    Tuition assistance, professional development and continuing education support

Benefits may vary based on the market and employment status.
 

Department:

It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a). Accordingly, all applicants will receive consideration for employment without regard to race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, or protected veteran status, and will not be discriminated against on the basis of disability. If you’d like to view a copy of the affirmative action plan or policy statement for Mercy Health– Youngstown, Ohio or Bon Secours – Franklin, Virginia; Petersburg, Virginia; and Emporia, Virginia, which are Affirmative Action and Equal Opportunity Employer, please email [email protected]. If you are an individual with a disability and would like to request a reasonable accommodation as part of the employment selection process, please contact The Talent Acquisition Team at [email protected].