Quorum Health

Medical writer

• Provides clinically based, concurrent and retrospective reviews of all inpatient medical records.
• Ensures documentation accurately reflects quality of care, severity of illness and risk of morality to support correct coding, reimbursement and quality initiatives.
• Proactively contacts physicians or other clinicians as needed to clarify procedures/diagnoses to ensure proper documentation.
• Performs initial case reviews and follow up reviews.
• Submits queries to providers as needed to ensure complete documentation of relevant diagnoses.
• Assigns diagnosis codes following the Official Guidelines for Coding and Reporting and AHA Coding Clinics to obtain an accurate working DRG.
• Promotes a partnership with Coding/HIM team to ensure the accuracy of principal diagnosis, procedures, and completeness of documentation to determine the working and final DRG, severity of illness and risk of mortality.

Clinical Documentation Integrity Specialist

Medical Billing and Coding

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance.
• Will match outpatient coding area to experience (i.e. Same Day Surgery, Routine Outpatient, Physician, Recurring, Observation, etc.).
• Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using 3M encoder, reviews Ambulatory Payment Classifications (APC) and coding edits.
• Reviews Local/National Coverage Determination (LCD/NCD) edits and guidance for codes meeting medical necessity.
• Research electronic medical record for any additional diagnoses documented to meet medical necessity.
• Ability to assign Physician E/M levels and charges for all relevant procedures performed in various settings, if applicable.
• Ability to assign injections and infusions, if applicable.

Outpatient Acute Care Coder

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
• Adheres to Standards of Ethical Coding (AHIMA).
• Reviews medical records to determine accurate required abstracting elements including appropriate discharge disposition.
• Knowledge of MS-DRG and APR DRG classifications and reimbursement structures.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and ICD-10-PCS coding.
• Comprehensive understanding of CCs/MCCs, impact on quality reporting, UHDDS guidelines, HACs and PSIs.
• The Inpatient Coder shall review hospital medical documentation to assign and sequence the appropriate principal diagnosis, secondary diagnoses and procedures utilizing ICD-10-CM, ICD-10-PCS codes with inpatient encounters to ensure proper coding, billing and compliance.
• Experience with compliant physician query writing.

Clinical Documentation Integrity Specialist

Outpatient Acute Care Coder

Coder – Day Surgery