Coder II

Description

Shift: Days

Job type: Full Time

Hours: 8am-5pm Mon-Fri

GENERAL DUTIES:

The Coder II is responsible for accurate coding and abstracting of clinical information from the medical record. The position is responsible for maintaining Tenet standards for coding data quality and integrity, as well as productivity within established guidelines. The Coder II is responsible for coding of Tenet facilities as assigned, assisting with productive coding to maintain DNFC, and assisting with the training of new coders, resolving coding edits, CARDS edits and/or other projects.

The Coder II codes and abstracts Ancillary, Emergency Department, Outpatient Surgery, Observation, or low acuity Inpatient encounters according to the Tenet Coding Quality Standards policy/procedure. Coding function includes diagnosis, PCS, CPT, HCPCS, modifiers, CARDS and coding edit resolution.

Responsibilities

DEPARTMENT SPECIFIC DUTIES:

Complies with established departmental policies and procedures, objectives, safety, environmental and infection control standards.

Cooperates with other personnel to achieve department objectives and maintain good employee relations.

Consistently demonstrates a professional and proactive attitude and actions in all interfaces with employees, hospital staff and physicians as well as patients.

Provides for privacy and patient/employee dignity by maintaining employee/patient and departmental confidentiality with no infractions.

Codes and abstracts all medical records for the purpose of reimbursement and research. Coding complies with federal regulations according to diagnoses, operations and procedures using ICD-10-CM, ICD-10-PCS, and CPT codes.

Accurately codes Ancillary, Emergency Department, Outpatient Surgery, Observation, or low acuity Inpatient encounters according to the Tenet Coding Quality Standards policy/procedure. Daily assures that all codes are entered into appropriate database on a daily basis

Reviews monitoring reports to assure that there are no outstanding accounts awaiting final diagnosis.

Serves as a liaison between medical records and the business offices of the hospital and the physician offices regarding any coding questions or discrepancies.

Assists in training in coding.

Responsible for continuing education and completion of lessons in LearnShare

Is always responsible for the maintenance of timely coding.

Performs other related duties as assigned or requested.

Understands HIPAA, privacy and confidentiality and demonstrates minimum necessary standard according to position

Qualifications

Required:

Minimum Education:

High School Diploma or GED equivalent

Minimum Experience:

2-5 years facility-based coding

Required Course (s) Training:

Completion of coding certificate program or associates or bachelor’s degree in health information management or related field

Skills-Machines:

Computer and phones

Skills-Administrative:

Working knowledge of MS Office Suite, electronic medical record, and encoder

Conditions:

Remote Office Setting

Preferred:

RHIT, CCS, and/or RHIA

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