Certified Coder II

Description: The Certified Coder II assigns diagnosis and procedure codes to day surgery, observation, maternal and newborn medical records utilizing International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) codes. (Potential Remote).

Typical Duties:

1. Assigns codes to diagnosis and procedures of Day Surgery, Outpatient Interventional Radiology, Outpatient Interventional Cardiology, and Observation patient records utilizing ICD and CPT codes in accordance with ICD Diagnosis Coding Guidelines, CPT Procedure Coding Guidelines, American Hospital Association (AHA) Coding Clinics and the JPS Outpatient Coding Procedures.


2. Assigns ICD diagnosis and procedure codes to all labor and delivery patients and all newborn records, including NICU, in accordance with the inpatient ICD Diagnosis and Procedure Coding guidelines, AHA Coding Clinics and the JPS Inpatient Coding Procedures. These patients are typically medium to complex clinically, and the coder must have an in-depth knowledge of anatomy, physiology, pharmacology, surgical instrumentation and maternal conditions and conditions of the newborn.


3. Confirms codes are sequenced correctly ensuring reimbursement is appropriate in accordance with government, insurance, and/or other payer regulations for Day Surgery, Interventional Radiology, Interventional Cardiology and Observation charts.


4. Ensures that the principle diagnosis is assigned and all secondary codes are sequenced appropriately to ensure the correct Medicare Severity Diagnosis Related Group (MSDRG) or All Payor Refined Diagnosis Related Group (APRDRG) assignment in mother and baby charts.


5. Determines diagnosis present on admission status and assigns the appropriate Diagnosis Related Group (DRG) for admitted patients.


6. Verifies each record that patient status, admitting/attending physician, admission date and time, discharge date and time, death date and time is accurate before coding and finalizing the chart. Makes changes as necessary.


7. Identifies, investigates, and corrects or routes accounts on the coding and billing edit work queues.


8. Queries the provider when documentation is determined to be insufficient, conflicting or ambiguous to elicit documentation reflecting the most accurate and specific conditions or procedures.


9. Maintains productivity and quality standards set forth in the Districts outpatient coding standards.


10. Demonstrates evidence of professional growth by attending coding workshops, conferences and or seminars, maintaining required C.E. requirements (departmental and professional), and individual study and education regarding coding, reimbursement, and HIM competencies.


11. Utilizes online and hard copy coding reference materials.


12. Performs other job related duties as assigned.