Edward-Elmhurst Health Hiring for Coding Reimbursement Spec at Warrenville, Illinois Full Time

GENERAL SUMMARY:

Under general supervision, codes discharge records according to diagnoses and operative procedures. In doing so, reviews clinical, diagnostic and treatment information in patients’ medical records to determine if required information for reimbursement and collection is present and ordered correctly. Codes according to guidelines.

CORPORATE PHILOSOPHY:

It is the obligation of each employee of Edward – Elmhurst Health to abide by and promote the mission and values of the System to ensure that excellent services are delivered with compassion

PRINCIPAL DUTIES AND RESPONSIBILITIES: (The following duties and responsibilities are all essential job functions, as defined by the ADA, except those that begin with the word “May.”)

1. Reviews patients’ medical records for clinical, diagnostic, and treatment information.

2. Codes and sequences acceptable data according to diagnoses and/or operative procedures using various numerical coding schemes, (e.g., ICD-10, CPT-4, etc). Refers to coding manual for selection of appropriate codes.

3. Enters data into computer to complete the medical record abstract and reviews same for accuracy. Abstracts patient medical records for use in statistical studies financial planning, trending and marketing by obtaining information such as diagnosis codes, procedures performed, and names of physicians involved.

• Determines and selects optimal Diagnostic Related Grouping (DRG) to be used for submitting to patient accounts for reimbursement. Reorganizes presentation of account if needed.

• Determines and selects Ambulatory Payment Classifications (APC) groups to be used for submitting to Patient Accounts for billing and reimbursement.

• Reviews charges for accuracy. Notifies supervisor when charges are missing and when claim fails Outpatient Code Edits (OCE).

• Enters Codes into Medical Necessity software for Outpatient procedures and diagnostic testing.

• Interfaces with patients to obtain diagnosis and procedure information at the point or registration or scheduling.

• Contacts physicians via telephone when documentation is needed to perform accurate coding and medical necessity assessments.

• Codes completed and verified data and identifies additional information required to affect DRG or accurately and completely code record. Notifies physicians, verbally or in writing, of need for additional information and returns record to same for completion, if appropriate.

• Reviews and repeats procedures described above after physicians have returned Attestation Form with complete information. Ensures corrections made by physicians and other medical personnel are properly recorded and complete.

• Perform various clerical duties as necessary including pulling charts, answering phones, and providing routine, factual information to physicians and other Hospital personnel upon request.

• Maintains confidentiality of patient medical record information at all times.

  KNOWLEDGE, SKILLS AND ABILITIES REQUIRED:

• Required Education and/or Experience:

• Associate’s Degree or higher in Health Information Management or related field

  Preferred Education and/or Experience:

• Minimum one year of previous medical records experience

• Required License and/or Certification:

• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) certification required within one year of position start date