Inpatient Coding Specialist

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Inpatient Coding Specialist is a vital multifaceted role within the Inpatient Coding Department. This position supports the Inpatient Coding Department and external customers as coding content experts, educators, resource expert including, but not limited to, medical coding of newborns, obstetrics, psychiatry, rehabilitation, medical and surgical coding. Responsibilities include activities contributing to the overall success of the Inpatient Coding Department as well as the health system. Performs a variety of coding duties to assure quality of coding and the efficient operation of the department. Provides significant education among the coders in the department as well as conducts regular audits on records completed.

EEO/AA/Disability/Veteran

• 1. Coding Expectations - Inpatient Coding Specialists are expected to perform basic coding functions within departmental established guidelines.
• 1.1. Expected to production code 20% of their time to stay current with trends in coding.
• 1.2. Maintains a minimum of 95% in coding quality scores for DRG validation as well as Total Data Quality.
• 2. Content Knowledge - Inpatient Coding Specialists are required to maintain industry specific certifications and remain up to date on changes within in the industry.
• 2.1. Maintains Certified Coding Specialist (CCS) designation per the guidelines set forth by the American Health Information Management Association.
• 2.2. Serves as the health system's content expert on inpatient coding.
• 2.3. Participates and seeks out career development activities by reading journals and coding articles and attending in-services and seminars and shares information with the department.
• 2.4. Regularly utilizes departmental resources to enhance knowledge base.
• 3. Financial - Inpatient Coding Specialists are expected to understand the financial impact of their primary duties and work to resolve issues in a timely manner.
• 3.1. Assists in meeting the corporate Candidate for Billing (CFB) goals by ensuring waiting cases are completed in the timeliest manner via daily review.
• 3.2. Analyses cases that are returned to coding for reviews from other partner departments (i.e. Billing, Denials, CDI, etc.). Completes all records from assigned work queues daily.
• 4. Education - Inpatient Coding Specialists are expected to lead by example and pass knowledge onto less experienced coders.
• 4.1. As assigned, trains, orients and mentors staff to the electronic tools and resources used to code medical records as well as the industry standard guidelines and processes and the departmental rules and guidelines to ensure correct and consistent coding and DRG assignment as reflected in QA statistics.
• 4.2. Coordinates weekly, monthly or quarterly meetings of their `specialty? area to disseminate information to ensure all staff are applying rules and guidelines in a consistent manner. In addition, communicates changes in ICD10 codes, Coding Clinic updates, etc.
• 4.3. Based on findings from an on-going audit process, develops and conducts staff training to ensure clear understanding and consistent practice among coders.
• 4.4. Provides answers to coding questions from both within and outside of the Inpatient Coding Department, included in this is the ability to provide sound rationales for the suggested coding or correction of the coding through the use of the coding tabular, UHDDS guidelines, Coding Clinics and other resources as needed.
• 4.5. Develops training material as needed using a Microsoft Office product. Tracks educational opportunities whether to an individual or group using a standard departmental tracking form and adheres to a standard procedure in completing the form.
• 5. Coding Compliance/ Institutional Risk - Inpatient Coding Specialists are expected to identify risk areas and work towards preventative strategies.
• 5.1. Focus of target records may change on occasion, however, audits will target high risk DRG's (AICD's, Gamma knife, pneumonia) according to the OIG, HCFA or any other governing body analyzing inpatient medical coding as an area of financial risk for the facility or the payer. Audits may stem from PEPPR Reports, new technologies (Mitra clip, Kcentra, Impella Pumps, etc.).
• 5.2. Audit results may require follow up audits on the same topics if themes are evident. Tracks findings on standard departmental findings form.
• 6. Clinical Documentation Improvement - Inpatient Coding Specialists are expected to identify documentation and coding query opportunities and refer them to CDI for resolution.
• 6.1. Maintains an active advanced knowledge of clinical indicators for all diagnoses as to identify clinical educational moments for staff and query opportunities for partner Clinical Documentation Improvement Specialists (CDIS).
• 6.2. Provides an educational link between Clinical Documentation Improvement Specialists (CDIS) and Inpatient Coding Team. Collaborates and communicates professionally with the CDIS department; responds to CDIS in a timely manner; provides CDIS with clear, concise coding education, as needed, to successfully complete the coding and includes coding resources as part of rationale/teaching moment.
• 7. Problem Solving - Inpatient Coding Specialists are expected to demonstrate flexibility and critical thinking throughout their workflow.
• 7.1. Troubleshoots billing issues in collaboration with billing staff and ensures the coding is correct per coding guidelines. Correct codes based on accurate coding guidelines and not for the purposes of billing.
• 7.2. Demonstrates critical thinking skills when presented with an issue and develops real time solutions to issues to see cases through to final completion.
• 7.3. Independently utilizes available resources to resolve coding issues.
• 7.4. Utilizes CDI for clinical review questions and documentation queries.
• 7.5. Demonstrates flexibility by accepting and completing other duties as assigned.
• 7.6. Capable of managing multiple priorities with deadlines.
• 7.7. May be required to work weekends and holidays as scheduled by leadership.
• 8. Reporting - Inpatient Coding Specialists will need to provide leadership data and reports occasionally.
• 8.1. Arranges data and information in a manner that could be presented to organization executives.
• 8.2. Presents data clearly and consistently to a departmental standard.
• 8.3. Provides statistical information to supervisor/manager for ongoing quality assurance to ensure department provides accurate medical information. Maintain activity logs as needed by management.
• 9. Standards of Performance & Communication - All YNHH employees are expected to demonstrate professional behavior and respect in all their interactions.
• 9.1. Adheres to Yale New Haven Health Standards of Professional Behavior: Patient-Centered Care, Respect, Compassion, Integrity, and Accountability.
• 9.2. Communicates in a professional and respectful manner to all individuals across the organization.
• 9.3. Exhibits enthusiasm for the profession and desire to move the department to more successful position.

EDUCATION

Bachelor's Degree preferred with additional training in medical terminology, anatomy, and physiology. Certified Coding Specialist (CCS) certification required. RHIT/RHIA preferred.

EXPERIENCE

Minimum of five (5) to seven (7) years' experience coding inpatient medical records. Actively involved in coding activities since implementation of ICD-10.

LICENSURE

CCS certification required. RHIT/RHIA preferred.

SPECIAL SKILLS

Ability to prioritize and organize the work of other. In-depth knowledge of medical terminology, anatomy, and physiology. Comprehensive understanding in use of ICD-10. Excellent oral and written communication skills, ability to exercise good judgment. Knowledge of personal computers and related software. Ability to train new and existing staff members in the application of all coding systems, as well as knowledge of the PPS system (DRG's and APC's) and ability to resolve coding and billing issues as it relates to the above.