Coder IV

Scope

1. This position assigns ICD-10 Clinical Modification (CM), Hierarchal Condition Category (HCC), and ICD-10 code Procedure Classification System (PCS) codes and Diagnosis Related Groups (DRG) to ensure accurate billing data for patient populations and publicly reported data. This position uses extensive knowledge and expertise to work alongside and collaborate with Clinical Documentation Integrity to review complex inpatient facility encounters and assign ICD-10 CM and PCS codes based on provider and clinical documentation.  It utilizes appropriate tools, resources, and guidelines to determine codes and assign the principal diagnosis and secondary diagnoses. Obtains clarification from physicians, clinical departments, and others on documentation questions as needed. Performs coding at an advanced level of complexity.

2. Audits and edits results of data provided by technology tools and resolves edits to send out a clean and accurate claim.

3. Performs coding at an advanced level of complex inpatient hospital coding complexity, such as Medicare and Medicaid charts with extended length of stay and multiple surgeries with extended consultations.

4. Collaborates with internal patient access to acquire correct and compliant diagnosis(es) to meet Advance Beneficiary Notice of Noncoverage (ABN) requirements and compliant billing regulations.

5. Maintains assigned work queues within defined processing time, meets productivity standards, and meets quality standards of 95% accuracy or better.  

6. Utilizes critical thinking thought process to assign appropriate clinical diagnosis and procedure codes in accordance with nationally recognized guidelines.

7. Verifies data abstracted and entered from the electronic health record (EHR). Ensures integrity of the database for internal and external data reporting.

8. Responds promptly to inquiries from revenue services related to the use of codes and modifiers within the billing process to assure accuracy and avoid delays in the billing process.

9. Adheres to all internal and external compliance guidelines. Participates in continuing education programs to maintain an understanding of anatomy, physiology, medical terminology, disease processes, and surgical techniques to support the effective application of coding guidelines and maintains credentials.

10. Stays abreast of coding guidelines, reimbursement methodologies, and regulatory compliance. Maintains thorough and current knowledge of clinical care and treatment options to critically assess appropriateness of

documentation. Thorough clinical knowledge of disease processes, pathophysiology, and pharmacology is required.

11. Assists as needed with billing/audit questions to ensure accurate reimbursement, facility inquiries,

education, statistical analysis, and the processing of internal audit reviews.

12. Identifies the need to clarify documentation in the medical record and communicates with physicians using the appropriate “query” tools according to the American Health Information Management Association (AHIMA) Guidelines for Achieving a Compliant Query Practice.

13. Promotes the mission, vision, and values of Intermountain Health, and abides by service behavior standards.

Minimum Qualifications

Coding credential from AHIMA or American Academy of Professional Coders (AAPC) required

OR ten (10) years of acute care inpatient facility coding experience.

Ability to work independently in a remote environment.
Demonstrates attention to detail for accuracy requirements. 

Preferred Qualifications

Minimum of three (3) years acute care facility coding experience which includes both ICD-10-CM & PCS coding with multidisciplinary service lines.

Understanding of billing, hospital reimbursement, and compliance background.

Ability to communicate effectively and diplomatically within a multi-functional team.

Experience with EPIC EHR and 3M 360 CAC, using 3M automation tools.

Experience with Microsoft Suite (Excel, Word, Outlook).