Coder Senior - Professional Coding and Auditing experienced (Eastern United Stat

Role Summary

Worker Type

Regular

Exemption Status

No

Health information coding is the transformation of verbal descriptions of diseases, injuries, and procedures into numeric or alphanumeric designations. The coding process reviews and analyzes health records to identify relevant diagnoses and procedures for distinct patient encounters. Coders are responsible for translating diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes that can be utilized for submitting claims to payers for reimbursement. A joint effort between the healthcare provider and the coder is essential to achieve complete and accurate documentation, code assignment, and reporting of diagnoses and procedures.

Responsibilities

Job Duties

Reviews the content of the medical record for hospital and professional inpatient or outpatient records to identify principal diagnosis, secondary diagnoses and procedures performed that explain the reason for service being provided or the admission and patient severity and comply with standard provider coding regulations.

Carefully details review of documents such as laboratory findings, radiology reports, various scan reports, discharge summary, history and physical, consultations, orders, progress notes and other ancillary services treatment records needed to ensure all pertinent diagnoses and procedures are recorded.

• Translates all diagnostic and procedural phrases utilized by healthcare providers into coded form procedure codes as required.
• Using the Encoder software program, determines the codes for all diagnoses and procedures.
• Determines their sequencing to legally maximize reimbursement.
• Assigns the appropriate DRG.
• Assigns codes based on hospital and professional coding guidelines, Coding Clinic directives, federal regulations, CCI coding initiatives, CPT Assistant or other standard coding guidelines.
• Queries physicians as needed to clarify documentation within the patient’s record to facilitate complete and accurate coding.
• Communicates to Coding Quality and Professional Manager any new diagnoses, procedures, technologies, etc.
• documented within patient records to ensure that appropriate diagnosis and procedure codes are selected and incorporated into hospital and professional coding guidelines.
• Provides and arranges training for coding professionals in the use of coding guidelines and practices, proper documentation techniques, medical terminology, and disease processes.
• Completes coding quality audit reviews to ensure all available cases were coded and entered into the hospital and professional computer system correctly and initiates Claim Action Reports as necessary.
• Develops coding policy and procedure or position papers related to correct coding for new or emerging technology services provided by clinical staff, and train coders on the use of that policy and procedure.

Work is typically performed in an office environment. Accountable for satisfying all job specific obligations and complying with all organization policies and procedures. The specific statements in this profile are not intended to be all-inclusive. They represent typical elements considered necessary to successfully perform the job.

*Relevant experience may be a combination of related work experience and/or completed specialty training program (1 year of specialty training = 1 year relevant experience).

Requirements

Position Details

Minimum of One relevant certification from AHIMA or AAPC is required upon hire. Acceptable certifications include:

AHIMA (American Health Information Management Association)

• Certified Coding Specialist (CCS)
• Certified Coding Specialist – Physician-based (CCS-P)
• Registered Health Information Technician (RHIT)
• Registered Health Information Administrator (RHIA)

Certified Coding Associate (CCA) – Candidates with only a CCA are required to obtain a CCS, RHIT, or RHIA within 12 months of hire.

• All certifications are acceptable from AAPC (American Academy of Professional Coders) except:
• Scribe, Documentation, Instructor, and International Credentials
• Certified Professional Biller (CPB)
• Revenue Cycle Management Specialist (RCMS)
• Certified Value-Based Administrator (CVBA)
• Certified Physician Practice Manager (CPPM)
• Certified Professional Compliance Officer (CPCO)

Education

• High School Diploma or Equivalent (GED)- (Required)
• Minimum of 7 years-Relevant experience* (Required)

Certification(s) and License(s)

Relevant coding certification - Default Issuing Body

Skills

• Communication, Computer Literacy, Medical Records Management, Medical Records Systems, Teamwork, Working Independently
• OUR PURPOSE & VALUES: Everything we do is about caring for our patients, our members, our students, our Geisinger family and our communities.
• KINDNESS: We strive to treat everyone as we would hope to be treated ourselves.
• EXCELLENCE: We treasure colleagues who humbly strive for excellence.
• LEARNING: We share our knowledge with the best and brightest to better prepare the caregivers for tomorrow.
• INNOVATION: We constantly seek new and better ways to care for our patients, our members, our community, and the nation.
• SAFETY: We provide a safe environment for our patients and members and the Geisinger family.
• We offer healthcare benefits for full time and part time positions from day one, including vision, dental and domestic partners. Perhaps just as important, we encourage an atmosphere of collaboration, cooperation and collegiality.

Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, pregnancy, genetic information, disability, status as a protected veteran, or any other protected category under applicable federal, state, and local laws.

• Days (United States of America)
• Scheduled Weekly Hours
• 40

About the Company

Why Join Geisinger ?

Geisinger cares about not only its patients and members but also about you and your family. We offer a competitive compensation and benefits package to ensure that you and your loved ones can maintain good health, achieve financial stability, and excel both personally and professionally. We believe in creating a diverse and inclusive environment where all employees can be their authentic selves. To learn more: