Inpatient Facility Coder – Health Information Management

Health Information Management Coder

Under the direction of the HIM Department Director and Coding Supervisor, this position maintains clinical databases through coding and abstracting of medical records. The coder assigns appropriate CPT, ICD-10, and HCPCS codes in accordance with Official Coding Guidelines, CMS guidelines, and internal policies. Demonstrates the ability to determine first listed diagnosis, secondary diagnoses, and surgical procedures. The HIM Outpatient coder collaborates with revenue integrity and patient financial services to resolve edits, verify code accuracy, and ensure claim processing. Receives and responds to educational feedback identified by Coding Compliance and Education. Achieves quality and quantity production standards, participates in professional development efforts, and maintains knowledge of medical record and provider documentation to maximize coding specificity with query opportunities.

Job Description

• Maintain clinical databases through coding and abstracting of medical records
• Assign appropriate CPT, ICD-10, and HCPCS codes in accordance with guidelines
• Determine first listed diagnosis, secondary diagnoses, and surgical procedures
• Collaborate with revenue integrity and patient financial services to resolve edits
• Verify code accuracy and ensure claim processing
• Respond to educational feedback from Coding Compliance and Education
• Achieve quality and quantity production standards
• Participate in professional development efforts
• Maintain knowledge of medical record and provider documentation

Requirements

• Oracle Cerner and/or 3M encoder knowledge preferred
• Excellent communication and interpersonal skills
• Aptitude for learning
• Preferred certifications: RHIT (Registered Health Information Technician), CCS (Certified Coding Specialist), RHIA (Registered Health Information Administrator), or other applicable Coding Certification through AHIMA or AAPC

Education

• Required: High School or Equivalent
• Preferred: Associate’s degree in health information management or related field of study

Schedule

After a successful onboarding period, the position is eligible for full-time remote work Monday – Friday.