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Trinity Health Auditor/IP Coder in Chelsea, Michigan

*Position Summary: *Responsible for coding inpatient, outpatient and emergency room healthcare records by assigning the appropriate ICD classification and/or CPT codes for all valid diagnoses and procedures. This information is used to determine MS-DRGs (Medicare Severity Diagnostic Related Groups) or APCs (Ambulatory Payment Classification) for data quantitative analysis, quality research and claim submission.

Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Revenue Excellence/Regional Health Ministry (RHM) Organization coding policies and CHE Trinity Health Coding Manual (TBA).

*Qualifications: *Minimum high school graduate. Must have current certification with AHIMA as a RHIT, RHIA, CCS, CPC or CCA. Three to five years recent coding experience in a hospital medical records department. Knowledgeable of ICD and CPT coding, reimbursement systems, medical terminology, anatomy and physiology/pharmacology, data collection techniques, and federal, state, and payor-specific regulations pertaining to documentation and coding.

Essential Functions and Responsibilities:

Reviews the Electronic Health Record to determine complete and accurate assignment of Principal diagnoses, Secondary diagnoses and significant procedures to assign appropriate ICD & CPT codes for data retrieval, research and reimbursement purposes.

Uses 3M HDM Computer Assisted Coding (CAC) and coding book to determine appropriate coding guidelines.

Abstracts inpatient and outpatient data into 3M Health Data Management abstract for research projects, quality improvement studies, statistical reporting and billing.

Utilizes 3M Audit Expert, NCCI & OCE edits, LCDs & NCDs to determine appropriateness and completeness of coding and health record documentation.

Codes accounts on a timely basis by payor's cut-off dates. Investigates and tracks unbilled accounts to determine reason for incomplete status and works with appropriate resources for completion.

Enters Observation, infusion, injection, extended recovery/PACU charges in PowerChart charge set as appropriate, using compliant physician orders.

Reviews Health Record to complete facility charge ticket to assign Evaluation and Management level charge.

Reviews Health Record for procedures performed and enters procedural charges into chargeset in PowerChart.

Utilizes Software systems for identification of patients/workload to include Vista, 3M HDM, and HealthQuest.

Collaborates with Medical Staff and Clinical Documentation Specialists to ensure that documentation in health record supports services provided to accurately and compliantly assign codes.

Facilitates communication and processes/resolves patient billing and service issues. Performs and assists with the writing of appeals for any coding or clinical denials.

Routinely provides CDS related duties/coverage.

Collaborates with members of various ancillary departments to complete special projects, also may serve on both intradepartmental and interdepartmental committees and task forces.

Utilizes written communication skills to respond to recommended coding changes made by external auditors. Serves as a resource for coding issues to other members of the organization/healthcare team.

Maintains continuing education credits for certification.

Performs the following functions related to medical record coding:

Assure optimal DRG and APC assignment based on documentation review and communication with the physician.

Identifies medical record documentation patterns/trends impacting coding and reimbursement and reports to Assistant Director or Director of HIM.

Queries physicians for clarification and/or additional documentation required for accurate and complete code assignment.

Abides by the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines.

Identify coding priorities and workflow to minimize A/R days.

Identifies and reports any risk compliance areas in coding and documentation practices.

Performs review and follow-up on coding audits.

Performs the following functions related to auditing:

Conducts auditing and monitoring of coding and abstracting completed by HIM coders.

Communicates discrepancies in coding and abstracting with the coders in a professional and supportive manner.

Conducts quality monitoring and reports findings to coders and manager on a routine basis.

Performs the following functions related to education and training:

Identifies educational opportunities and training for ICD 10 related coding including the sharing of new Coding Clinic information.

Maintains good rapport and cooperative relationships.

Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participates in their resolution.

Maintains the confidentiality of information acquired pertaining to patient, physicians, employees, and visitors to St. Joseph Mercy Chelsea/Saint Joseph Mercy Health System.

Discusses patient and hospital information only among appropriate personnel in appropriately private places.

Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Conducts all activities in accordance with the Mission, Vision and Values of St. Joseph Mercy Chelsea/Saint Joseph Mercy Health System.

Maintains competency by attending and participating in webinars, seminars and training sessions as assigned.

Maintains knowledge to perform the duties of the job.

Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.

Demonstrates self-directed learning. Identifies and assists in resolution of problems related to safety, sanitation and maintenance of the environment. Practices effective communication in all interactions (patient, visitor, co-worker, colleagues).

Promotes a positive work environment by demonstrating teamwork.

Other Functions and Responsibilities

Performs other duties as assigned.

Required Education, Experience and Certification/Licensure

Minimum high school graduate Must have current certification with AHIMA as a RHIT, RHIA, CCS, CPC or CCA Three to five years recent coding experience in a hospital medical records department

Required Skills and Abilities

Interpersonal skills necessary to effectively interact with coding team, medical staff and other healthcare departments. Analytical skill necessary to resolve issues. Ability to interpret medical terminology in order to review chart documentation and understand coding process. Ability to concentrate and pay close attention to detail for more than 80 percent of work time. Willingness to cooperate and work toward solutions, which support a common goal. Ability to work independently with minimal supervision, organize work and set priorities. Knowledgeable of ICD and CPT-4 coding, reimbursement systems, medical terminology, anatomy and physiology/pharmacology, data collection techniques, and federal, state, and payor-specific regulations pertaining to documentation and coding. Meets Trinity Health coding productivity and quality standards.

This document is intended to describe the generalized duties and responsibilities, the specialized job functions, and the essential requirements of this job. It is not intended to be an exhaustive statement of all supplemental duties, responsibilities, or non-essential requirements or reflect any accommodations made under the American’s with Disability Act, the Michigan Handicapper’s Act, or SJMHS’s Return to Work Program

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Job Number: 00146698

Location: Chelsea, MI

Organization Name: Saint Joseph Mercy Health System

Facility: SJSEMI - SJMHS Chelsea Comm Hospital

Employment Type: Full time

Shift: Day Shift

Hours: 40

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