Medical Records Coder III in Valhalla, New York at Westchester Medical Center

Distinguishing Features of the Class: Under general supervision, an incumbent of this class is responsible for addressing appeals to insurance companies and coding highly complex medical records, including all diagnoses and operative and diagnostic procedures in patient medical records, and entering coded information into an automated grouper system. This class differs from the Medical Records Coder II in that addressing appeals is distinctive to this class and the level of knowledge required is greater. Supervision is not a responsibility of this class, however, technical guidance and acting in a lead role is expected. Does related work as required.

Examples of Work: (Illustrative Only)

Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement;

Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures;

Identifies and analyzes patterns in possible coding errors or other trends and reports to the Supervising Medical Records Coder;

Participates in mandated medical record review processes;

Using the current HCPCS, ICD and CPT coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record;

Ensures that all factors necessary for assigning an accurate DRG are present, and that all diagnoses are ranked properly;

Makes appropriate contacts in order to acquire or clarify necessary information;

Enters final diagnostic code numbers and narrative descriptions of diagnoses and procedures into an automated grouper system;

Compiles and updates the appeal log detailing denials, hospital's reply and follow-up responses;

Responds to inquiries regarding medical documentation and DRG'S and provides information to Utilization, Quality, Patient Accounts, Risk and other hospital staff, as required;

Abstracts information from medical records to compile reports and statistical information;

Enters data such as diagnosis, treatment, admission and discharge dates, and length of stay on hospital-wide or regional automated database;

May train lower level coders and provide technical guidance and expertise.

Required Knowledge, Skills, Abilities and Attributes: Comprehensive knowledge of the American Hospital Association Official Coding Guidelines; comprehensive knowledge of the current HCPCS, CPT and ICD codes; thorough knowledge of DRG and APC classification systems; thorough knowledge of medical terminology; thorough knowledge of the principles of the unit medical record system and its operation; ability to understand and code medical records; ability to communicate effectively both orally and in writing; ability to effectively use computer applications or other automated systems such as spreadsheets, word processing, calendar, e-mail and database software in performing work assignments; assertiveness; thoroughness; sound judgment; tact; discretion; initiative; accuracy; physical condition commensurate with the demands of the position.

Minimum Acceptable Training and Experience: High school or equivalency diploma, six years of experience where the primary function of the position was medical records coding in or for a hospital, two years of which included coding trauma cases, and either: (a) possession of a CPC credential from the American Academy of Professional Coders or (b) possession of a CCS, or CCS-P, or RHIA, or RHIT credential from the American Health Information Management Association.

Substitution: Satisfactory completion of 30 credits* toward a degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience. There is no substitute for the two years of experience coding trauma cases.

*Special Note: Education beyond the secondary level must be from an institution recognized or accredited by the Board of Regents of the New York State Education Department as a post-secondary, degree-granting institution.