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Billings Clinic HIM Specialty Coder II in Billings, Montana

HIM Specialty Coder II CODING RESOURCES Non-Exempt req1080 Shift: Day
Employment Status: Full-Time (.75 or greater) Hours per Pay Period: 1.00
= 80 hours Starting Wage DOE: 22.22 -27.78 The HIM Specialty Coder II
position is responsible for coding and abstracting diagnoses and
procedures from patient charts using ICD-CM, ICD PCS and/or CPT-4/HCPCS
codes for statistical and reimbursement purposes for all Billings Clinic
inpatient and outpatient services. Alternatively, since Billings Clinic
is an integrated delivery system, responsible for auditing or assigning
CPT and E&M codes to clinic encounters by reading dictation, reviewing
problem lists and intake forms, capturing primary and secondary ICD-CM
diagnoses, adding HCPCS modifiers where necessary and verifying units of
service for pharmacy items and supplies. Queries physicians to clarify
clinical documentation. Educates physicians either concurrently or
after-the-fact on coding and documentation and serves as an on-site
resource for providers and staff. Calculates the MSDRG and APR- DRG.
Ensures adherence to all Billings Clinic and regulatory compliance
policies and procedures governing medical records coding, billing and
reimbursement. Essential Job Functions • Supports and models behaviors
consistent with Billings Clinic’s mission, vision, values, code of
business conduct and service expectations. Meets all mandatory
organizational and departmental requirements. Maintains competency in
all organizational, departmental and outside agency standards as it
relates to the environment, employee, patient safety or job performance.
• Maintains a detailed knowledge of and ensures adherence to all
applicable Billings Clinic and regulatory compliance policies/procedures
governing medical record coding, insurance billing and reimbursement
methodologies in all aspects of the job. Actively seeks out
clarification and/or updated information to ensure most current
guidelines are followed. • Review of medical records for documentation
to identify the principal diagnosis and/or procedure and all applicable
secondary diagnosis and procedures • Assigning the appropriate ICD-CM,
ICD-PCS and/or CPT-4/HCPCS codes for each encounter utilizing ICD-9 and
CPT-4 books. • Utilizing the computerized encoding system and/or coding
books to facilitate accurate coding and sequencing of diagnosis and
procedures by following all regulatory compliance policies and
procedures governing medical records coding, billing and reimbursement.
• Calculating a DRG or APC for each inpatient visit/encounter and/or
physician visits/services coding to appropriately and legitimately and
ethically optimize the payment based on approved coding guidelines and
standards • Assigns POA for inpatient facility coding. • Captures any
missing charges. • Maintains or exceeds 95% coding accuracy based on
audit findings. • Maintains or exceeds department productivity standards
for assigned areas of coding. • Identifies and reports any regulatory or
compliance concerns to Manager, Director and/or Billings Clinic
Corporate • Compliance Department. • Ensures accuracy of data prior to
billing interface and claims submission. (i.e. discharge disposition,
appropriate use of modifiers, CPT,ICD, preforming provider, date of
service, POA, NCCI and other coding edits, etc. ) • Collects data from
the medical record to complete a discharge data abstract on each
encounter for specialized studies. • Communicates with
physicians/Non-Physician Providers to provide coding and documentation
education and feedback. • Identifies needs and sets goals for own growth
and development; meets all mandatory organizational and departmental
requirements. Maintains knowledge of current information and
technologies for coding and abstracting arena. • Maintains competency in
all organizational, departmental and outside agency environmental,
employee or patient safety standards relevant to job performance. •
Performs other duties as assigned or needed to meet the needs of the
department/organization. • Health Information Coder III Additional
Essential Functions • Assists and supports leadership within the
assigned department(s). Participates in and provides input and feedback
into interviewing, hiring, performance appraisal and disciplinary
processes. Participates in scheduling, establishing priorities and
assigning workloads, orientation/training • Assesses quality on a weekly
basis for by conducting quality reviews. Measures results against
established quality standards and maintains statistical reports on the
outcomes of the quality reviews. Provides feedback and follows up as
needed to improve quality and/or provide education/training. Knowledge,
Skills, and Abilities • Billings Clinic policy and procedures, both
organizational and departmental • Billings Clinic Corporate Compliance
Program • Billings Clinic Code of Business Conduct • Personal computers,
hardware and software • HIPAA and confidentiality requirements •
Customer service techniques and Personal Service Excellence (PSE) skills
• Patient’s/resident’s rights • Medical terminology, anatomy and
physiology • Risk adjusted coding methodology • Coding and compliance
guidelines and regulations for government and various third party payers
• Physician office billing policies and procedures • ICD-CM, ICD-PCS
and/or CPT-4/HCPCS coding • DRG and/or APC reimbursement methodologies •
Professional communication skills, both verbal and written • Utilization
of personal computer and related software and hardware • Interpreting
and analyzing medical documentation to make correct coding assignments •
Maintaining knowledge of current regulatory and compliance requirements
as they related to coding • Incorporate population specific needs into
all aspects of communication and patient care; scope of services
provided will encompass age groups from infant through geriatric •
Communicate clearly and effectively, both verbal and written • Establish
and maintain collaborative relationships • Type 45 WPM with accuracy •
Act independently in highly complex situations • Make sound decisions
and follow through • Utilize more than one source in a complex coding
process • Analyze information from the patient’s medical record •
Perform high quality work while maintaining production levels within the
established standards • Operate required office machines and equipment •
Work effectively in a team environment • Work independently with minimal
supervision • Work with frequent interruptions and competing priorities
• Utilize time management concepts and maximize time effectively •
Interpret policies and procedures, identify non-compliance and take
appropriate action • The consequences of an incorrect coding assignment
can result in an increased compliance risk, loss of reimbursement and
intensified auditing reviews as well as difficulty providing credible
data for various special studies. • It is critical that the person in
this position have a detailed knowledge and understanding of the varied
and continually changing reimbursement and compliance
regulations/guidelines and apply that knowledge to ensure Billings
Clinic coding and billing adheres to those regulations/guidelines at all
times. Minimum Qualifications • Demonstrated knowledge of technical
specialty such as Interventional Radiology, IP Facility, Radiation
Oncology, Cardiac Cath lab, or multiple areas/specialties of coding to
provide coverage in multiple areas. - government regulations -commercial
payer guidelines and regulations - billing practices - auditing
practices • Specialty certification desirable or to be obtained within
two (2) years of hire or as agreed upon with the Manager. ( CCS, RCC,
ROCC, etc.) • Coding training and experience related to technical
specialty such as Interventional Radiology, IP Facility, Radiation
Oncology, Cardiac Cath lab, or multiple areas/specialties of coding to
provide coverage in multiple areas. - government regulations -commercial
payer guidelines and regulations - billing practices - auditing
practices • Clinic: Ability to perform complex coding requirements
across all assigned specialties within the physician clinic • Hospital:
Ability to perform complex coding requirements within the hospital for
IP patient types and for all types of third party and government payers.
• Takes action with minimal input or supervision. For situations outside
the normal guidelines and/or procedures, formulates recommendations for
review and consideration by the management team. • Able to proactively
identify reimbursement issues. Ability to work pre-billing edits.
Ability to work denials. Ability to perform auditing. • Ability to
incorporate cultural diversity and age appropriate care into all aspects
of communication and assigned services. • Interpersonal skills which
enable the incumbent to respond to a variety of complex inquiries and
requests from payers and physicians. • Ability to deal with difficult
situations in a mature and professional manner. Interpersonal skills to
assist with training and to respond to questions and assist with problem
resolution from Level II Coders. • Trains & mentors specialty coders in
assigned area. • Assigned to one of the specialty areas: Radiation
Oncology, Interventional Radiology, Cardiac Cath Lab & IP Facility ,
Coding Float, Cirius/Denials • May provide back up to other areas of the
Coding Resources department. • Ability to provide support in multiple
areas including the pre-bill scrubber system, denial management, and
responding to requests from Patient Financial services, in addition to
assigned specialty area. • Ability to determine proper procedures for
resolving complex coding issues with minimal supervision • Empowered to
utilize independent judgment to investigate and research pertinent data
and formulate an action plan. Monitors all high dollar discharges to
ensure high levels of coding quality. • Presents recommendations for
review and consideration by the management team for problem scenarios
outside of established procedures • Serves as a trainer & mentor to
specialty coders in assigned area. Assists with problem resolution.
Billings Clinic is Montana’s largest health system serving Montana,
Wyoming and the western Dakotas. A not-for-profit organization led by a
physician CEO, the health system is governed by a board of community
members, nurses and physicians. Billings Clinic includes an integrated
multi-specialty group practice, tertiary care hospital and trauma
center, based in Billings, Montana. Learn more Billings Clinic is committed to the
principles of Equal Employment Opportunity. All policies and processes
are designed toward achieving fair and equitable treatment of all
employees and job applicants. Employees are encouraged to discuss any
concerns they have in this regard with their immediate supervisor and/or
the Vice President People Resources. All employees and job applicants
will be provided the same treatment in all aspects of the employment
relationship, regardless of race, color, creed, religion, national
origin, gender, gender identity, sexual orientation, age, marital
status, genetic information or disability.