Coding Specialist III

Possesses the knowledge and skills to thoroughly review the clinical content of inpatient medical records of all levels of complexity and assign appropriate ICD-10 codes to diagnoses and procedures for optimal reimbursement. Ensures coding accurately reflects severity of illness and risk of mortality for quality reporting. Has knowledge of other coding types, including outpatient, outpatient surgery, and observation, with the primary focus on complex inpatient coding.

Principal job functions

• Review hospital inpatient medical record documentation and assign ICD-10-CM and/or ICD-10-PCS codes for reportable diagnoses and procedures.
• Determine principal diagnosis, comorbidities and complications, secondary conditions, surgical procedures, MS-DRG, APR-DRG, POA indicators, and hospital acquired conditions.
• Review discharge disposition codes for accuracy.
• Apply technical coding principles and MS-DRG reimbursement expertise while abstracting assignments according to facility guidelines.
• Maintain quality standards of 95% accuracy while meeting productivity expectations.
• Stay current on Official Coding Guidelines, MAC directives, coding compliance standards, and local and national medical review policies.
• Help identify solutions to reduce and resolve back-end coding edits.
• Query physicians when documentation is unclear and follow up as needed.
• Provide education to healthcare professionals and medical staff on coding guidelines, documentation practices, and query monitoring.
• Assist with coding quality review activities for accuracy and compliance.
• Mentor and train new coding staff members.
• Ensure all coding is accurate and meets turnaround standards.
• Follow organizational policies, procedures, regulations, and ethical coding standards.
• Maintain professional growth through seminars, workshops, and professional affiliations.
• Participate in meetings, committees, and department projects as assigned.