Employment Type:

Shift:

Description:

POSITION PURPOSE

Provides high level technical competency and subject matter expertise analyzing physician/provider documentation contained in assigned Complex Outpatient (CO) and/or Inpatient health records to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Provides appropriate Medical Severity Diagnostic Related Groups (MS-DRG), Present on Admission (POA), Severity of Illness (SOI) & Risk of Mortality (ROM) assignments for Inpatient records and accurate APC assignments and all required modifiers for Complex Outpatient records.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification diagnosis and procedure codes, Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes, MS-DRG, POA, SOI & ROM assignments and assignment of APC’s and all required modifiers.

Utilizes coding guidelines established by the Centers for Medicare/Medicaid Services (CMS), American Hospital Association (AHA) Coding Clinic, American Medical Association (AMA) for CPT codes and CPT Assistant, American Health Information Management Association (AHIMA) Standards of Ethical Coding, Revenue Excellence/Regional Health Ministry (RHM) coding policies.

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs. Codes Complex Outpatient or Inpatient utilizing encoder software and online tools and references, in the assignment of ICD, CPT, HCPCS codes, MS-DRG, POA, SOI & ROM assignments, APC assignment and all required modifiers. Validates and/or revises charges by comparing charges with health record documentation as necessary. Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtained from the health record. Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Specialists (CDS) regarding documentation issues or needs related to Inpatient coding. Formulates compliant clarifications/queries following Trinity Health’s documentation integrity procedures. Collaborates with Patient Financial Services in resolving billing and utilization issues affecting reimbursement. Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems. Tracks issues (i.e., missing documentation, charges or Inpatient queries that require follow-up to facilitate coding in a timely fashion. Consistently meets or exceeds coding quality and productivity standards established by Revenue Excellence/RHM. Adheres to Trinity Health and RHM confidentiality requirements as they relate to the release of any individual or aggregate patient information. Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations. Performs other duties as assigned by leadership. Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

Our Commitment to Diversity and Inclusion

Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.

Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.