Reviews medical records of all outpatient surgery (including other non-ancillary outpatient accounts) payer types to determine the principal diagnosis and procedure.
Utilizes query forms to consult with physician when documentation clarification is necessary
Following all regulatory guidelines, utilizes technical coding principals and APC reimbursement expertise to assign appropriate ICD-9/10 PCS diagnoses and ICD-9/10 CPT procedures
Using the International Classification of Diseases (ICD9/10) and the Current Procedural Terminology (CPT) coding classification systems, assigns codes to all diagnoses and procedures following applicable coding principals and department guidelines; enters into the computer coding system
Abstracts and codes all required clinical and demographic data for reporting to CMS (Centers for Medicare and Medicaid Services), OSHPD (Office of Statewide Health Planning and Development), Quality Management, and Medical Staff; enters information into the computer abstracting system
Maintains current knowledge of the most recent ICD-9-CM/ICD-10 CM/PCS Official Guidelines for Coding and Reporting, the annual changes to the ICD9/10 diagnosis and procedure codes, the annual changes to the inpatient perspective payment system, CPT procedure codes, as well as the quarterly changes to the APC reimbursement system, and the annual changes to the reporting and reimbursement system
Demonstrates the ability to accurately and timely code all medical records, including Medicare, to expedite hospital reimbursement, clinical pertinence and indices
Demonstrates the ability to take job ownership by offering suggestions and showing a commitment to job completion
Job Specific Competencies
Has basic office skills and computer knowledge
Communicates effectively with supervisor, peers and others requiring interactions
Achieves optimal APC reimbursement
Meets facility standards for correct diagnoses and procedure code assignment (ie. accuracy goals)
Meets facility standards for QM data/physician assignment/OSHPD required data
Meets WAR report productivity goals 97% of the time
Minimum Requirements / Work Experience
3 years ICD-10 coding and APC reimbursement experience in an acute care hospital
Expert knowledge of coding SDS, Cath Lab, Infusions, OBS.
Education / Licensure / Certification
At least one CCS, RHIT or RHIA required
Internal Number: MEM003670
Let us introduce ourselves. We're MemorialCare, a nonprofit health system that includes four hospitals, two medical groups, imaging centers, surgical centers and much more. As one of the leading health systems in Orange County and Los Angeles County, we're confident that no matter what your needs are, we have the teams, tools and know-how to support you every step of the way.