The DRG Team Lead will code all patient types as needed: inpatient, same-day surgery, ancillary and ambulatory. Also will assist in completing the Edits in SFM and in TruBridge two hours per day or when asked to perform the task.   This individual will mentor, train and assist with cross training coding staff, includes newly hired coding staff.  Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and procedures for hospital and outpatient services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.

Daily Functions:

·         Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.

·         Codes complex outpatient or inpatient utilizing encoder software  and references  in the assignment of ICD-10-CM/PCS, CPT/HCPCS codes, MS-DRG, APR-DRG, POA, SOI, ROM assignments, APC assignment and all required modifiers.

·         Validates charges by comparing charges with health record documentation as necessary.

·         Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.

·         Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.

·         Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.

·         Tracks issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.

·         Consistently meets or exceeds coding quality and productivity standards established by coding department.

·         Adheres to JSH confidentiality requirements as they relate to release of any individual or aggregate patient information.

·         Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.

·         Performs other duties as assigned by leadership.

·         Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

EXPERIENCE QUALIFICATIONS

Required: HS Diploma and 5 years of experience, or Associate’s and 3 years of experience

Preferred: Associate’s degree in Coding (or similar Field)

EDUCATION QUALIFICATIONS

Associate Degree in health information management or related field or an equivalent combination of years of education and experience

LICENSES AND CERTIFICATIONS

Certified Coding Specialist (CCS), or  Certified Inpatient Coder (CIC)

SKILLS AND ABILITIES

•                    Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding and MS-DRG or APC grouping.

•                    Experience utilizing encoding/grouping software.

•                    Ability to use standard desktop and windows based computer system, including basic understanding of email, internet, and computer navigation.

•                    High ethical standards.

•                    Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.

•                    Experience in ICD-10-CM/PCS coding and reimbursement training.

•                    Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.

•                    Extensive knowledge of hospital and professional coding including provider based billing.

•                    Knowledge of documentation regulations of Joint Commission and CMS.

•                    Experience with concurrent coding reviews.

•                    Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.

•                    Experience in assisting and identifying learning needs as well as providing training to coding staff.

•                    Strong analytical abilities and problem-solving skills.

•                    Excellent oral, written and interpersonal communication skills.

•                    Ability to organize and set priorities to ensure objectives are met in a timely manner.

•                    Ability to adapt to change and handle challenges proactively and with pose.

•                    Ability to effectively collaborate with physicians and managerial staff at all levels.

•                    Provides a positive and professional representation of the organization.

•                    Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention.

•                    Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience.

•                    Maintains competency and knowledge of current standards of practice, trends, and developments in related scope of job role or practice.

•                    Adheres to infection-control policies and protocols, medication administration and storage procedures, and controlled substance regulations.

•                    Participates in ongoing quality improvement activities.

•                    Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards.

•                    Complies with organizational and regulatory policies for handling confidential patient information.

•                    Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization.

•                    Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements, and TJC standards and/or standards from other accrediting bodies.

•                    As a Studer Partner must have the ability to develop a full understanding of the Studer Group practices and tools and communicate effectively. Must embrace the Studer Philosophy and Principals by conducting him/herself in a professional manner.

Will be held accountable to the following Studer Philosophies and Principles:

•                    HCAPS Patient Perception

•                    AIDET

•                    Daily Huddles

EXPERIENCE QUALIFICATIONS

Required: HS Diploma and 5 years of experience, or Associate’s and 3 years of experience

Preferred: Associate’s degree in Coding (or similar Field)

EDUCATION QUALIFICATIONS

Associate Degree in health information management or related field or an equivalent combination of years of education and experience