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The Certified Inpatient Coder/Analyst is responsible for the review and analysis of medical records of all patients discharged from the hospital and the assignment of appropriate diagnostic and procedural codes following established coding principles and guidelines in the American Hospital Association’s ICD-10-CM Coding Handbook. The Coder is responsible for translating the diagnostic and procedural language utilized by healthcare providers into coded information. The Coder must also determine the appropriate sequencing of diagnoses and procedures to assure legitimate and compliant DRG/MS-DRG assignment. The coded information is utilized for reimbursement purposes, in the assessment of clinical care, to support medical research activity, and to support the identification of healthcare concerns critical to the public at large.
The Certified Inpatient Coder/Analyst must have a thorough understanding of the content of the medical record in order to locate information to support and provide specificity for coding. The Coder must be trained in the anatomy and physiology of the human body and disease processes in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, prognosis of diseases and procedures to be coded, and must have proficiency in multiple specialty areas. The Coder must apply his or her knowledge of disease processes and procedural techniques to the coding process to avoid coding errors. The work of the Coder directly determines reimbursement for each discharge. The Coder works as a team with the CDI Specialists to achieve accuracy and consistency in documentation and data quality and to serve as a resource for other departments. The Coder must have the ability to work independently from home.
We offer 1-2 weeks of paid training. The hours during training will be 8:00am to 5:00pm, Monday - Friday.
Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
- Assigns appropriate codes to inpatient charts to maintain accurate and current information for billing, statistics and research
- (Certified IP Coder/Analyst I) Selects medical records to be coded from the HIM Coding ASU and OPO work queues, processing oldest discharges first. Reviews HPF notes for missing documentation, outstanding queries, or leave day roll-ups before beginning the coding review
- (Certified IP Coder/Analyst II) Selects medical records to be coded from the HIM Coding IP work queue, processing oldest discharges first. Reviews HPF notes for missing documentation, outstanding queries, or leave day roll-ups before beginning the coding review
- Analyzes patient medical records and interprets documentation to identify all diagnoses and procedures. Assigns ICD-10-CM diagnosis and procedures codes to all pertinent diagnoses, comorbidities, major co-morbidities and procedures in accordance with all regulatory guidelines, with a minimum of 92% accuracy according to peer, manager and/or external consultant review
- Enters codes into 3M, analyzes groupings, and accurately determines the sequencing of diagnoses to assure appropriate and compliant grouping and DRG assignment with a minimum of 92% accuracy according to peer, manager and/or external consultant review
- Verifies discharge disposition and, if inaccurate in billing system, revises it for accurate and compliant reimbursement.
- (Certified IP Coder/Analyst II) Accurately assigns POA indicators for all diagnoses
- (Certified IP Coder/Analyst II) Verifies accuracy of infant birth weight in billing system.
- Prepares and prints a coding summary for each case after entering appropriate information into 3M
- Strives to meet or exceed Inpatient Coder/Analyst productivity standards established by the HIM Director and HIM Coding Manager. This standard is three records per hour calculated on 6-hour days. Meetings and education sessions will be factored into productivity calculations
- Identifies potential leave day situations and enters a note for that record in the HPF work queue. Tracks discharges with leave days that are to be rolled up as per HIM practice avoiding billing delays and admission denials by payers.
- (IP Certified Coder/Analyst II) When present in the medical record being coded, reviews CDI worksheet and compares the concurrent DRG assignment to the final DRG determination. If DRGs are not the same, communicates with the applicable CDIS to determine the most accurate DRG
- Maintains communication with providers and Finance Department to ensure appropriate reimbursement as established by departmental guidelines
- In conjunction with the Clinical Documentation Improvement Specialists, queries providers to obtain clarification of diagnoses or procedures when medical record documentation is incomplete or ambiguous for coding purposes
- Responds to requests from the Finance Department for DRG clarification within 3 days as determined by feedback from Finance
- Acts as a resource for coding and DRG information for the organization as observed by HIM Coding Manager and feedback from providers and other departments
- Adheres to reporting requirements by state registries, responds to DRG insurance denials, and participates in reviews as required by regulatory agencies
- Accurately identifies patients with congenital malformations, as defined by the New York State Congenital Malformation Registry, abstracts information required by the CMR and submits it to the DRG Coordinator within 10 days of patient discharge
- (IP Certified Coder/Analyst II) Conducts chart review and researches payor DRG denials, as assigned by manager or DRG Coordinator
- Participates in focused care reviews, as requested by the HIM Coding Manager, based upon internal and external data reports
- Follows Hospital safety policies, Departmental policies and HIPAA-Confidentiality policies
- Follows hospital safety policies 100% of the time as observed by management and feedback from co-workers
- Applies principles of body mechanics, such as proper lifting and keyboarding techniques 100% of the time as indicated by manger review of incident and variance reports annually
- Uses equipment as directed by supervisor and or policy instructional manual as observed by supervisor/manager.
- Understands the importance of reading and referring to the Departmental Instructional manual and follows the practices outlined as observed by management, co-workers and customers
- Upholds the Confidentiality oath taken and maintains strict confidentiality on all forms of medical-patient PHI as observed by co-workers, management and customers
- Maintains coding credential, as defined by the American Health Information Management Association and the American Academy of Professional Coders, and assures that the HIM Manager has a copy of current certification at the time of annual evaluation
- Performs similar or related duties as requested or directed
- Conducts research on clinical conditions and provides educational presentations to the Inpatient Coding Team
- Participates in clinical project team work as applicable to the Inpatient Coding Program and as requested by the Coding Manager
- Performs other duties as requested by the HIM Coding Manager or DRG Coordinator
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- High School diploma / GED (or higher)
- CPC, CCS, RHIT, or RHIA certification or CCA with completion of CPC, CCS, RHIT or RHIA within one year of hire
- Certified Inpatient Coder/Analyst II: CPC, CCS, RHIT or RHIA certification
- 3+ years experience in outpatient coding and/or hospital billing
- 1+ years experience as a hospital-based ambulatory surgery or inpatient coder, or completion of an accredited RHIT or RHIA residency
- 3+ years experience as a Certified Inpatient Coder/Analyst
- Knowledge of CPT, ICD-10-CM and Diagnosis Related Groups (DRGs)
- Familiar with PCs and Microsoft Office products (Word-copy, paste, ect., Excel-copy, paste, create, ect.)
- You will be asked to perform this role in an office setting or other company location, however, may be required to work from home temporarily due to space limitations
- Reside within the Eastern or Central time zone
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
- If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders
- Associate's Degree (or higher)
- Experience with encoder products, 3M Coding and Reimbursement System encoder
- Ability to sit for prolonged periods of time at a computer workstation
- Repetitive use of hand and fingers on computer keyboard
- Comfortable working from two computer monitors
UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.
You can learn more about all we are doing to fight COVID-19 and support impacted communities at: https://www.unitedhealthgroup.com/newsroom/addressing-covid.html
Military & Veterans find your next mission:
We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
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