Overview The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient and/or professional fee encounters using appropriate ICD10/ICDPCS, CPT, or HCPCs codes and appropriate coding software such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters.
Responsibilities
Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient. Provides interdepartmental coding assistance, as needed, to determine accurate coding assignment. Develops methodology to provide a coding process that is compliant with regulatory agencies including the utilization of reference materials such as, but not limited to, Center for Medicare Services (CMS) publications, Coding Clinic, CPT Assistant, etc. Facilitates optimization of revenue while maintaining compliance standards for the organization through varied venues and tasks (auditing/monitoring, training, facilitation of charges through the claim scrubber system, assisting with various patient or payor related charge/account inquiries, research on various coding/billing related topics as requested by various sources internal and external to the organization, etc.). Serves as an expert resource regarding CPT, HCPCS, ICD-10-CM, all other necessary coding systems, and regulatory guidelines for all internal and external parties. Serve as liaison for coding and billing staff to ensure accurate charge capture. Reports any documentation and coding improvement needs based upon review findings. Responsible for maintaining coding certification, knowledge and skills to successfuly perform job duties Performs provider and peer coding audits as requested Assist with monitoring of internal controls for coding and billing. Facilitates external audit activities and reporting of such activities to the appropriate administrative personnel.
Qualifications
Certifications: Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC); Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC); Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC); Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA); Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Education: , Work Experience: Carle Health Company Overview Find it here. Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois. We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health. We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.
