Cape Fear Valley Health System is searching for a Clinical Coding Specialist II to be located in Fayetteville, North Carolina.
This nonexempt position (465-21) is located within the Health Information Management Department.
Responsible to: Manager Coding and Statistics.
Direct Line of Promotion: Senior Clinical Coding Specialist.
Reviews thoroughly the entire medical record to code specifically and accurately those conditions or diagnoses that were treated or affected the patient’s plan of care. Verifies that each medical record contains appropriate documentation to justify the selected principal diagnosis to identify comorbid conditions, complications and procedures to use for DRG Assignment. Maintains an accurate case mix index from which administration makes critical management and strategic planning decisions.
Major Job Functions:
The following is a summary of the major essential functions of this job. The incumbent may perform other duties, both major and minor, that are not mentioned below; and specific functions may change from time to time.
1. Uses a computerized encoder and DRG grouper, and ICD-9-CM coding books to transform verbal descriptions of diseases, injuries, symptoms and procedures into alphanumerical designations/codes.
2. Concurrently assigns DRG on LTAC and acute care inpatients with LOS > 60 days on inpatient admissions using a computerized encoder and DRG grouper. Provides concurrent coding data to include diagnosis, procedures and LOS for use by Case Management and Patient Financial Services as a tool for use in the justification of continued stay for patient admissions and concurrent assessment of potential in-house revenue.
3. With full understanding of PPS regulations, PRO review policies and procedures, and the DRG classification system, explains to and communicates with physicians regarding the changing of principal diagnoses on the attestation statement, based on lab and other diagnostic findings, when the record may be subjected to PRO review due to vague attestation/documentation.
4. Assesses the adequacy of documentation to ensure that it supports the principal diagnosis, principal procedure and complications and comorbid conditions that are coded. Refers any case to Coordination of Care for assessment when it appears a denial may be issued.
5. Performs DRG validation on Medicare admissions that are assigned a DRG by the Clinical Documentation Specialist. Assists with education of CDMP nurses on coding guidelines when educational opportunities are identified.
6. Contacts lab, pathology, cardiac diagnostic center and other ancillary departments to obtain results of outstanding tests when necessary for accurate DRG assignment.
7. Analyzes clinical findings to determine appropriate secondary diagnoses for patient severity indices.
8. Uses independent judgment as to prioritizing charts for retrospective coding based on management of the unbilled accounts report.
9. Uses tact and diplomacy in all communications with physicians and other hospital personnel.
10. Uses good judgment in determining when to delay billing for obtaining additional documentation to support the assignment of a more optimal DRG.
11. Makes coding manager aware of problem issues, negative physician communication and/or other influences that impact effectiveness of job performance.
12. Performs other duties as assigned by the Senior Coding Specialist or the Coding Manager.
The following qualifications, or equivalents are the minimum requirements necessary to perform the essential functions of this job:
1. Education and formal training:
-Bachelor’s Degree in Health Information Management or equivalent training and experience.
-RHIA, RHIT, CCS or other equivalent credentials required.
-Medical terminology, anatomy and physiology; familiarity with medical record content and an understanding of the Uniform Hospital Discharge Data Set (UHDDS) definitions.
-Knowledge of ICD-9-CM coding principles under Prospective Payment System.
2. Work Experience:
-Five (5+) years coding experience required, preferably in a hospital setting.
-Two years inpatient coding preferred.
-Experience in a Health Information Management Dept. in an acute care facility, or with a Peer Review Organization, in Quality Assurance, or Utilization Review preferred.
3. Knowledge, skills and abilities required:
-Excellent communication skills required.
-Highly independent in that decisions are made with very serious impact affecting hospital reimbursement and PRO review determinations.
-High degree of interpretation, analysis, planning, coordination, and organization of information.
-Decisions require intense mental effort and consideration of reimbursement ramifications.
-Utilizes past experience, practices and organization to accomplish goals. -Assigns accurate codes using good judgment in a timely manner within broad guidelines.
-Must be flexible and able to concentrate in a busy, noisy, and crowded environment with demands and interruptions 75% of the time.
4. Physical Requirements: Near visual acuity required and motor coordination required to operate computer. Work requires commuting between nursing units and Medical Record Department.
When applying for this position, please include the reference code HIPjobs-6073.
To apply directly please go to:
<a href=”Clincial Coding Specialist II
Cape Fear Valley Health System is an Equal Opportunity Employer.
The cornerstone of Cape Fear Valley Hospital was laid in 1954, and the hospital opened in 1956 as a 200-bed county hospital. Having grown to a 765-bed facility, today, Cape Fear Valley is a robust medical center located in the growing metropolitan city of Fayetteville, NC (population 115,603) in Cumberland County (population 319,431). Cape Fear Valley Medical Center specializes in heart care, cancer treatment and surgical services. We have a full-service Risk Labor and Delivery department as well as a Level-III Neonatal Intensive Care Unit (UNIT) to care for the tiniest members of our community. We also have “The Children’s Center”, which shares the floor with our Pediatric Intensive Care Unit (PICU). A half-century after its opening day, Cape Fear Valley Medical Center is the healthcare provider of choice for thousands of families in the Cape Fear Region.