Job Description

Join to apply for the Senior Inpatient Coder (REMOTE) role at Westchester Medical Center Health Network

Job Summary

The Senior Inpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records using the current International Classification of Diseases (ICD-10-CM/PCS codes) and entering coded information into an automated grouper system. The role includes providing technical guidance and acting as a lead.

Responsibilities

1. Address appeals to insurance denials to facilitate expedient resolution and reimbursement.


2. Interpret and apply American Hospital Association Official Coding guidelines to support diagnoses and procedures.


3. Identify and analyze patterns in coding errors or trends, reporting to the coding leadership team.


4. Participate in mandated medical record review processes.


5. Assign and record accurate codes for diagnoses, procedures, and operations using ICD-10-CM/PCS, based on physician documentation.


6. Query physicians for documentation clarification.


7. Ensure all factors necessary for accurate DRG assignment are present and diagnoses are properly ranked.


8. Maintain an appeal log detailing denials, responses, and follow-ups.


9. Respond to inquiries regarding medical documentation and DRGs from hospital staff.


10. Abstract information from medical records for reports and statistics.


11. Potentially train lower-level coders and provide technical guidance.


12. Resolve bill holds promptly to maintain DNFB and coding queues.


13. Act as a liaison between Patient Accounting and Coding departments.

Qualifications/Requirements

1. Minimum of three years of inpatient coding experience in an acute care setting.


2. Proficiency in ICD-10-CM and ICD-10-PCS, demonstrated by passing a coding assessment.


3. High School diploma or equivalency required.


4. Substitutions for experience include 30 college credits per year of experience (up to four years), but no substitution for specialized experience.


5. Current CCS certification required.


6. Preferred: RHIA or RHIT certification.


7. Knowledge of AHA Coding Guidelines, ICD-10-CM/PCS, DRG classification, medical terminology, anatomy, and physiology.


8. Effective communication skills and proficiency with computer applications.

Additional Details

• Seniority level: Not Applicable


• Employment type: Full-time


• Job function: Health Care Provider


• Industries: Hospitals and Healthcare

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