Coding Specialist III

Possesses the knowledge and skills to thoroughly review the clinical content of complex inpatient medical records 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. Also has knowledge of other coding types, including outpatient, outpatient surgery, and observation, with the primary focus on complex inpatient coding.

Principal Job Functions

• Commits to the KRMC mission, vision, values, and goals and consistently demonstrates core values.
• Reviews hospital inpatient medical record documentation and assigns ICD-10-CM and/or ICD-10-PCS codes for all reportable diagnoses and procedures.
• Determines the correct principal diagnosis, comorbidities, complications, secondary conditions, surgical procedures, MS-DRG, APR-DRG, present on admission indicators, and hospital-acquired conditions.
• Reviews discharge disposition codes for accuracy.
• Uses technical coding principles and MS-DRG reimbursement expertise to assign diagnosis and procedure codes and abstract assignments according to facility guidelines.
• Meets or exceeds the established quality standard of 95% accuracy while maintaining department productivity standards.
• Maintains current knowledge of Official Coding Guidelines, Medicare Administrative Contractor directives, coding compliance standards, and local and national medical review policies.
• Assists in identifying solutions to reduce and resolve back-end coding edits.
• Queries physicians when documentation is unclear and follows up on queries.
• Provides education to healthcare professionals and medical staff on coding guidelines, documentation techniques, and query monitoring to support documentation improvement activities.
• Assists with coding quality review activities for accuracy and compliance.
• Mentors and trains new coding staff members.
• Works collaboratively to ensure all coding is accurate and meets turnaround standards.
• Adheres to relevant policies, procedures, regulations, and expectations of Bryan Medical Center.
• Abides by AHIMA Code of Ethics and Standards for Ethical Coding and follows all Official Coding Guidelines.
• Maintains professional growth through seminars, workshops, and professional affiliations.
• Participates in meetings, committees, and department projects as assigned.
• Performs other related projects and duties as assigned.