Hospital Coding Specialist Senior

Position Summary

At Orlando Health, we are ordinary people with extraordinary individuality, working together to bring help, healing and hope to those we serve. By daily embodying our over 100-year legacy, we reinforce our reputation as a trusted and respected healthcare organization that delivers professional and compassionate care to our patients, families and communities. Through our award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities, our 27,000+ team members serve communities that span Florida’s east to west coasts and beyond.

ORLANDO HEALTH - BENEFITS & PERKS:

All Inclusive Benefits (start day one)

• Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.

Forbes Recognizes Orlando Health as a Best-In-State Employer

• Forbes has named Orlando Health as one of America's Best-In-State Employers for 2024. Orlando Health is the top healthcare organization in the Metro Orlando area to make the prestigious list. "We are proud to be named once again as a best place to work," said Karen Frenier, VP (HR). "This achievement reflects our positive culture and efforts to ensure that all team members feel respected, supported and valued.

Position Summary

Multifacility responsibility for complete and accurate coding of all levels (low, intermediate, and complex) inpatient hospital visits for entire Orlando Health system purposes of billing in compliance with State and Federal regulations.

Responsibilities

Essential Functions 

• Perform high level review and analysis of clinical documentation and accurately assign diagnosis and procedure codes for multifacility all levels of inpatient visits using ICD-10-CM/PCS classification systems+, utilizing EPIC Electronic Medical Record (EMR), encoder, computer assisted coding (CAC), and other applications as applicable.
• Appropriately sequence principal and secondary diagnoses and procedures for proper MS and APR-DRG assignment, following applicable coding conventions, Official Guidelines on Coding and Reporting, and Center for Medicare and Medicaid Services (CMS) guidelines.
• Query physicians for clarification of documentation discrepancies and inconsistencies for additional diagnoses, complications, co-morbid conditions, or procedures, as needed.
• Applies appropriate present on admission codes and discharge diagnosis status.
• Accurately abstracts information into the hospital information system(s).
• Completes concurrent reviews for purposes of documentation enhancement, interim billing, etc.
• Assists the coding liaisons and management team in medical record reviews for third party audits, denied claims, medical necessity, pre-bill reviews, focused audits, etc.
• Communicates cooperatively and constructively with physicians, physicians’ office personnel, guests, patients and members of the healthcare team.
• Collaborates with Clinical Document Excellence (CDE), Quality Management and other departments to determine appropriate DRG assignment for compliance and reimbursement purposes.
• Demonstrates understanding of mortality and other coding impacted quality initiatives, and key performance indicators.
• Demonstrates high level critical thinking skills to include problem resolution and process improvement skills and balancing reimbursement considerations with regulatory compliance.
• Demonstrate extensive knowledge and understanding of coding guidelines, procedures, medical necessity/CCI edits and the APC
• reimbursement system and keeps abreast of current coding changes and standards of care to maintain and shares expertise to the team.
• Provides coding guidance insight based on expertise to coding team.
• Works independently to coordinate information and workflow of corporate functional area.
• Interacts with coding and other teams to ensure completion of corporate and departmental goals.
• Tracks/trends opportunities for physician education.
• Works with Patient Accounting and ancillary areas to assure appropriate and timely billing on all accounts.
• Collects and provides data for statistical reports to coding management team as required.
• Maintains level of productivity established by department.
• Assist with new team member precepting, as needed.
• Cross trains in all aspects in coding based on department need.
• Perform other duties as assigned.
• Participates quality audits and maintains 95% or better accuracy.
• Demonstrates exemplary customer service and strong verbal and written communication skills
• Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), and adheres to official guidelines
• Assures confidentiality of patient information.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions 

• Maintains established work production standards.
• Works as a team member in facilitating efficient and effective problem solving to meet goals.
• Establishes and maintains an environment of positive motivation through individual and group interaction.
• Assumes responsibility for professional growth and development.
• Attends department and other meetings as required.

Qualifications

Education/ Training

• High School Diploma or equivalent required.
• Associate degree or coding certificate program preferred.
• Computer literacy.
• Medical terminology, anatomy and physiology required, measured on coding skills test.
• Score of 90% or better on Orlando Health Sr. level coding skills test required.

Licensure/ Certification 

• Must maintain one of the following certifications:
• Certified Coding Specialist (CCS)
• Certified Professional Coder (CPC)
• Certified Outpatient Coder (COC)
• Certified Professional Coder – Hospital (CPC-H)
• Registered Health Information Administrator (RHIA)
• Registered Health Information Technician (RHIT)

Experience

• 5 Years previous hospital inpatient and/or outpatient coding experience required
• 1 Year teaching hospital coding experience preferred