|Employer:||Brigham and Women's Hospital
|Skills:||Coding and/or charging,Coding classification systems including ICD-10-CM,ICD-10-PCS and/or CPT-4/HCPCS
|Specialties:||Biology, Anatomy and Physiology, Basic Pathology
|Required Certifications:||RHIA,RHIT or CCS by AHIMA or appropriate AAPC coding credentials required
|Required Experience:||3 to 4 years
|Location:|| Boston 02115, MA, US
Reporting to Patient Access Services Director, and/or under the direction of a designee, the Brigham Health Coder is responsible for accurate coding and/or charging of inpatient and/or outpatient (may include same day surgery, observation,) for the both the Brigham and Women’s Hospital and Brigham-Faulkner Hospital accounts based on medical record documentation. The coder will utilize coding classification systems including ICD-10-CM, ICD-10-PCS and/or CPT-4/HCPCS as well as other specialty systems as required by diagnostic category. Assures appropriate assignment of DRG, APC and APG's. All work is carried out in accordance with the department's approved polices and procedures
PRINCIPAL DUTIES AND RESPONSIBILITIES:
- Codes all ICD-10-CM diagnoses and/or ICD-10-PCS and CPT-4/HCPCS procedures according to the appropriate classification system for the category of patient encounter and based on relevant medical record documentation.
- Adheres to and follows Official Coding Guidelines, AHIMA Standards of Ethical Coding and facility-specific coding guidance when assigning diagnoses and procedures; grouping for the DRG; establishing E/M levels; and/or resolving coding related claim edits.
- Completes coding, charging and/or coding related claim edit resolution with an error rate of no less than 95% and maintains an average productivity level at or above the established coding role benchmark.
- Utilizes available coding related resources and references to research and support coding decisions and seeks input from department subject matter experts as needed.
- Follows code sequencing instructions, POA criteria and use of modifiers as applicable.
- Demonstrates understanding of the Prospective Payment Systems methodologies, i.e. DRG, APG/APC.
- Demonstrates initiative and follows specified procedures to resolve issues with accounts that cannot be coded.
- If necessary, and depending on coding role, requests clarification for incomplete, illegible, contradicting or unclear documentation either directly or through the Data Quality Specialist for Clinical Documentation Specialist.
- Participates in on-going quality control programs that includes the following: reviews with Data Quality Specialist, Technical Advisors and/or 3rd party vendors. Updates accounts as needed and adheres to any remediation programs established for areas of deficiency.
- Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care, casemix, and fiscal reimbursement.
- Proactively practices departmental and hospital confidentiality policies and procedures. Responsible to perform any and all other assigned duties as requested.
- Recognizes and understands the role of a coder in the department and how it relates to the overall function of the hospital regarding patient care, casemix, and fiscal reimbursement
- Attends department staff meetings and other PHS and Revenue Cycle Operations meetings as directed
- Participates and completes department-sponsored workshops and continuing education programs germane to clinical processes and coding.
- May be asked to assist with training and workflow reviews for new staff
- Performs coding, charging and/or claim edit resolution responsibilities for any entity covered by PHS Coding as needed.
- Assists with medical necessity appeals for denials that result from non-covered CPT code denials.
- Works proactively with physician Practices to develop coding toolkits and to assist schedulers
- Demonstrates good working knowledge of EPIC WQ’s and reporting to help ensure that the coding is correct for authorizations for Brigham and Women’s Hospital and Brigham-Faulkner hospital.
- Assists the Insurance Support Coordinator in the ERU to identify changes to procedures real time based on Op note and documentation on a daily basis.
- Works with the Patient Access Services Authorization team to resolve coding issues for authorizations and becomes familiar with payor requirements.
- Assigned to special projects as needed to assist with coding issues.
- AS or BS in Health Information Technology/Administration OR CCS/CPC
- A minimum of 3 years of coding experience in an acute care setting, relevant to coder role is required. College level courses in medical terminology, biology, anatomy and physiology, basic pathology, ICD-10-CM/PCS and CPT coding are required. ICD-9-CM experience is a plus.
- RHIA, RHIT or CCS by AHIMA or appropriate AAPC coding credentials required.
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
- Other medical related backgrounds will be considered provided that coding related casework and experience meet requirements.
- Up-to-date and in-depth knowledge of anatomy, physiology, medical science, medical terminology, normal and abnormal laboratory values, and generic and brand name drugs for a thorough review of the paper and/or computerized medical record for abstracting and coding accuracy and completion.
- Expert knowledge of ICD-10-CM/ICD-10-PCS and/or CPT/HCPCS coding systems (relevant to coding role) to assign the most precise code possible and to abstract specific clinical data to support hospital-wide case mix activities.
- Exercises judgment to review the medical record for ambiguities and/or contradictory material; able to discern when another coder and/or physician opinion is needed.
- Ability to process work, error free, within presented deadlines and time frames.
- Strong analytical skills and ability to pay close attention to detail.
- Ability to work as a team player.
- Demonstrates the ability to assume responsibility for professional development and on-going education to maintain proficiency.
- Ability to accept constructive analysis based on feedback from inside/outside auditors, and quality improvement initiatives.
- Maintain confidentiality with regard to Protected Health Information (PHI).
- Ability to withstand the pressure of continual deadlines and receipt of work with variable requirements.
- Ability to be courteous, tactful, and cooperative throughout the working day.
- Ability to communicate clearly and professionally, both written and verbal, with all levels of staff and personnel within the organization.
- Competency and understanding of how to use standard office equipment such as desktop computers and telephones and computer applications that facilitate communication such as email, teleconference, web conference.