CODING INTEGRITY SPECIALIST II

General Description:

Reviews and evaluates hospital outpatient medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM and Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes. Performs coding and/or code validation across OUH. Applies all appropriate coding guidelines and criteria for code selections.

Essential Responsibilities:

Responsibilities listed in this section are core to the position. Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position.

• Using, ICD-10-CM and/or HCPCS/CPT, primarily assigns, validates, and/or edits codes the following patient types:
  • Same day surgery (SDC)
  • Observation (OBV)
  • Wound Care
  • Outpatient Cardiac Cath

• As needed, may also assign, validate, and/or edit codes for the following patient types:
  • Emergency department (ED)
  • Recurring (RCR)
  • Clinical (CLI) records, and/or
  • Provider Office Visit (POV)

• Assigns, validates, and/or edits procedure categories, modifiers (when applicable)
• Maintains or exceeds established productivity standards
• Maintains or exceeds established accuracy standards
• Initiates, validates, and/or edits physician queries in compliance with Company policy where appropriate
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current
• Utilizes the complete medical record documentation in code assignment, validation, and/or editing of codes
• Follows all applicable coding guidance in assigning, sequencing, validation, and/or editing of codes
• Meets all educational requirements as stated in current Company policy

General Responsibilities:

• Performs other duties as assigned

Minimum Qualifications:

Education: None required.Associates or Bachelor's degree in HIM/HIT preferred.

Experience: One (1) year acute care observation and/or same day surgery hospital outpatient coding experience required.

Or equivalent combination of education and experience

Licensure/Certifications/Registrations Required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) required

Knowledge, Skills and Abilities:

• Coding Technical Skills- ICD-10-CM, HCPCS/CPT-4, and APCs.
• Analytical Skills - effective evaluation, synthesis and use of information gathered.
• Organization - establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi-task.
• Communication - communicates clearly and concisely.
• Customer Orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• PC Skills - demonstrates proficiency in Microsoft Office applications and others as required.
• Quality Orientation - accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
• Work Independently - is self-supporting; not needing to rely on others to complete a job.