Senior Inpatient Coder

Summary

Join the University of Maryland Medical System as an Inpatient Coder! Under direct supervision, you will accurately code hospital inpatient accounts for reimbursement, research, and compliance. You will serve as a clinical coding expert, analyzing complex cases and collaborating with medical staff. Responsibilities include maintaining coding accuracy and productivity rates, communicating with various departments, and ensuring compliance with AHIMA standards. This role requires a high school diploma or equivalent, ICD-10-CM/PCS coding experience, and a relevant certification. A degree and additional experience are preferred.

Requirements

• High School graduate or equivalent
• Formal ICD-10-CM and CPT training
• Minimum of three years ICD-10-CM/ICD-10-PCS coding and abstracting experience with at a Level 1 Trauma and Rehab hospital or 4 years of experience with coding inpatient hospital medical records
• One of the following: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Inpatient Coder (CIC)

Responsibilities

• Serve as a clinical coding subject matter expert, and utilize critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed
• Analyze, code and abstract complex inpatient cases such as trauma, rehab, neurology, critical care, etc. utilizing the ICD-10-CM and ICD-10-PCS nomenclature to ensure accurate APR-DRG/SOI/ROM and POA assignment
• Utilizes critical thinking to analyze and evaluate documentation issues with consultation from the medical and clinical staff, and clinical documentation specialists as needed
• Collaborates with other senior coders (and the other coding staff) with sharing coding information and providing coding advice to colleagues regarding complex cases to be coded
• Monitors assigned work on a daily basis in order to facilitate the billing process within the established timeframes. Codes and abstracts records within timeframes established for each patient type
• Maintains coding quality accuracy rate of 90%
• Maintains productivity rate of 95%
• Communicates with various departments within the hospitals regarding billing and registration issues. Refers any problems to management timely, providing clear details. Compose appropriate coding queries, work collaboratively with CDI, understand Potentially Preventable Complications (PPC’s)/Maryland Hospital Acquired Conditions (MHAC’s), and Prevention Quality Indicators (PQI’s) and their impact
• Communicates with the Auditing team to discuss audit findings and working collaboratively in making sure that all accounts are coded appropriately and meet standards of compliance
• Complies with AHIMA standards of ethical coding and coding compliance guidelines
• Demonstrates support and compliance with University of Maryland Medical System mission, vision, values statement, goals and objectives and policies. Performs other duties or projects such as coding corrections as assigned by the manager

Preferred Qualifications

• Associates or Bachelor’s degree
• Strong analytical and organizational skills; filing systems; ability to prioritize workloads; meet deadlines and work effectively under pressure; excellent customer service skills; general office procedures; ability to problem solve and work with minimal supervision; familiar with basic medical terminology; computer experience; typing ability