Senior Coder

Overview

This remote position encompasses a diverse range of coding responsibilities, including outpatient facility coding (Diagnostic, Observation, Endo, & Surgery), evaluation and management (E / M) level coding for clinical office visits, and professional fee coding. Placement will be determined based on experience, and comprehensive cross training can be provided to ensure proficiency across all areas. The Senior Coder acts as a lead coder for their designated team, trains staff on department policies, procedures, systems and correct coding requirements, audits Coders, fills in for out-of-office Coders, and makes recommendations to Coding Leadership to improve team efficiency.

Responsibilities

• Selects appropriate assignments for coding from assigned work queues.
• Assigns codes by encounter : selecting the accurate principal diagnosis and procedure code; sequencing codes to optimize reimbursement in conformance with policies; coding only diagnoses and procedures which can be substantiated by documentation in the medical record; following coding guidelines; and contacting physicians for clarification when documentation is conflicting or ambiguous.
• Verifies charges entered for the encounter match the documentation contained within the record where defined in policy.
• Routes to department when charges do not agree.
• Correctly utilizes coding applications & systems to code and abstract all assigned encounters.
• Analyzes APCs and Modifier assignments to ensure data is accurate and compliant.
• Uses knowledge of ICD and CPT rules, guidelines and requirements to select appropriate codes.
• does not change codes or narratives to misrepresent meanings; maintains focus on ethical coding and quality data.
• Consults physicians for clarification when documentation is conflicting or ambiguous and assists physicians unfamiliar with ICD, CPT or DRG methodology.
• Strives for optimal payment to which the facility is legally entitled and adheres to regulatory guidelines.
• Reviews unbilled records to ensure coding within department timeframes.
• Maintains confidentiality of patient, medical record, department, and employee information.
• Demonstrates a positive attitude and fosters teamwork; assists others as needed.
• Monitors coding backlog and errors; works with other departments to correct inaccurate clinical or demographic information.
• Reviews APC grouper edits and assists in clearing edits related to coding and compliance.
• Assists with orientation and training of new employees; provides input to supervisor regarding coding policies and procedures.
• Fulfills yearly continuing education requirements of the department and hospital, including safety and mandatory in-services; responsible for maintaining credentials.
• Attends and participates in department or section meetings; contributes to the overall operation of the department by performing other duties as assigned.

Qualifications

Where You'll Work

Inspired by faith. Driven by innovation. Powered by humankindness. CommonSpirit Health is building a healthier future for all through its integrated health services. As one of the nation's largest nonprofit Catholic healthcare organizations, CommonSpirit Health delivers more than 20 million patient encounters annually through more than 2,300 clinics, care sites and 137 hospital-based locations, in addition to its home-based services and virtual care offerings. CommonSpirit has more than 157,000 employees, 45,000 nurses and 25,000 physicians and advanced practice providers across 24 states and contributes more than $4.2 billion annually in charity care, community benefits and unreimbursed government programs. Together with our patients, physicians, partners, and communities, we are creating a more just, equitable, and innovative healthcare delivery system.

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