Coder II (inpatient)
GENERAL SUMMARY: Under the general supervision of the HIS Coordinator for Data Quality (Coding Manager) and according to established policies and procedures, assigns ICD9-CM and CPT-4 codes to medical record information. Determines appropriate DRG, AP-DRG, ASC, APG assignment for optimal reimbursement. Abstracts required data into the Medical Center's computerized data base. The outcome of information gathered is used to determine Medical Center statistics, case mix, and reimbursement of Hospital claims. PRINCIPAL DUTIES AND RESPONSIBILITIES: 1. Analyzes patient medical records and interprets documentation to identify all diagnoses and procedures. Assigns proper ICD-9-CM and CPT-4 diagnostic and operative procedure codes to inpatient, TCU, surgical day care, observation, emergency, and selected outpatient records by reference to computerized/written coding aids and other reference material. Consults with the appropriate physician to clarify medical record information. 2. Assigns grouper codes to each record according to patient type and financial class (AP-DRG, HCFA-DRG, ASC, APG). Enters coded/abstracted information in grouper, analyzes groupings, and assigns the appropriate grouper for optimal reimbursement. Data enters abstracted demographic/clinical information into the Medical Center's computerized abstracting database. 3. Prepares and prints coding summaries for each required case by entering the appropriate case mix data. Notifies physicians that statements are needed for signature as necessary; follows up on their return in a timely manner.4. Works with Patient Accounts and Admitting on problem accounts. Answers physician/clinician questions regarding coding principles, DRG assignment, and prospective payment systems groupers and optimization. Assists Finance, Information Systems, and other departments with coding/DRG issues. 5. Monitors and retrieves missing records to close the month. Works the unbilled report for missing diagnoses. Performs clerical functions specific to each hospital. Assists with record processing and main office backup as needed.
KNOWLEDGE, EXPERIENCE AND OTHER JOB REQUIREMENTS: 1. Level of knowledge equivalent to that ordinarily acquired through completion of an Associate's Degree in medical record technology. 2. Six to twelve months of inpatient ICD-9-CM coding experience in an acute care facility. 3. Eligible for designation as an ART, RRA or CCS.WORKING CONDITIONS: 1. Normal office environment. The above statements are intended to describe the general nature and level of the work being performed by people assigned to this job. They are not exhaustive lists of all duties, responsibilities, knowledge, skills and abilities associated with the job.
Primary Location: Framingham, MA
Hospital/Facility: MetroWest Framingham Union Hospital
Shift Type: Days