HIM Coder

Cost Center

165 Health Information Management

Scheduled Weekly Hours

40

Work Shift

First Shift (United States of America)

Shift & Status

Who Are We?

We at Pine Rest believe in the power of healing and that everyone in our community has the right to expert care for mental health and substance use disorders. We are much more than just the third largest non-profit behavioral health system in the country, our 220-acre main campus, and our network of clinical sites across Michigan. We are a tight-knit community of healers who witness the impact of our life-changing work each day.

Each day, we are closing the gaps in access to care. We are innovating through leading-edge research, testing, programs, and treatment modalities that others replicate across the country. Our services include a state-of-the-art psychiatric urgent care center and a soon-to-be-built pediatric behavioral health center, outpatient, inpatient, partial hospitalization (day programs), assessment and testing, residential, addiction treatment and specialty services such as crisis response, employee assistance programs, forensic psychiatry and psychology, and neuromodulation. On-the-job educational programs for nurses, psychologists, advanced practice providers, psychiatrists, and chaplains are equipping the next generation of care providers.

We are passionate about serving and are honored to be a part of this incredible work.

What Will you Do?

As a HIM Coder at Pine Rest, you’ll be part of tight-knit team that believes in the healing power of your expertise and compassion. You’ll be responsible for the timely and accurate coding review of all HRS and ORS records for the purpose of reimbursement and compliance with regulatory agencies according to diagnoses and procedures guidelines in both Facility and Professional Services. The following are general characteristics of this job classification. Specific duties and areas of responsibility for this position within each department shall be defined by the department manager or director. The HIM Coder must demonstrate excellent customer service and have enthusiasm about the program and the Pine Rest organization.

Our HIM Coders are dedicated to excellent customer service, enthusiastic about the care we offer, and foster a sense of belonging and empowerment in a diverse workplace.

Principal Duties and Responsibilities:

• Accurately applies professional and facilities coding principles to HRS inpatient, Partial, PUCC, Residential, and ORS clinic encounters.

  • For inpatient: concurrently analyze code assignment and sequence to assure proper DRG assignments; sequence codes in compliance with ICD-10 Official Coding Guidelines, Uniform Hospital Discharge Data Set (UHDDS) and other regulatory requirements to accurately assign the DRG.

  • For outpatient: analyze code assignment and sequence to assure proper APC assignments; sequence codes incompliance with ICD-10 Official Coding Guidelines, and other regulatory requirements to accurately assign the APC.

  • For professional: analyze code assignment and sequence to assure proper CPT/HCPCS and diagnosis assignment.

• Identify cases with clinical indicators that may require provider documentation clarification and/or specificity to accurately assign codes and, accurately formulate provider queries, when needed.

• Complete well-timed follow-up case reviews on all concurrent cases with priority given for resolution of those with clinical documentation clarifications

• Analyze the medical record documentation for complications and comorbidities.

• Confirm Admission-Discharge-Transfer (ADT) information and correct, when necessary

• Demonstrates a thorough knowledge of ICD 10-CM/PCS medical coding, DRG’s, CPT, and APC’s.

• Demonstrates a thorough working knowledge of medical terminology and asks questions to clarify misunderstandings.

• Demonstrates a complete understanding of all coding principles regarding the sequencing of diagnoses and procedures.

• Demonstrates knowledge of human anatomy and physiology to interpret general medical and mental/behavioral health classifications for coding.

• Must be able to work and communicate effectively with providers, managers, and peers across HRS, ORS, and support departments, as needed. 

• Recognizes opportunities for ensuring completeness and consistency of patient documentation. Uses critical thinking and sound judgment in decision making keeping reimbursement considerations in balance with documentation compliance.

• Gives accurate attention to details.

• As required, actively participates in performance improvement projects.

• Demonstrates a consistent level of performance; strives to maintain a steady level of productivity.

• Ensures professional coding accuracy rate of 90% or better on quarterly coding audits.

• Ensures facility coding accuracy rate of 95% or better on quarterly coding audits.

• Adapts to changes in the workload.

• Will be required to work in a highly confidential area without disclosure of confidential information. 

• Complies in all material respects with the Corporate Compliance Policy and all federal, State and local laws and regulations applicable to position. 

• Notifies manager or the Corporate Integrity Officer if any violations are suspected.

What Does the Role Require?

Education/Experience:

• Required certification as RHIA, RHIT, CCS, or other medical coding certification

• Preferred 1-3 years coding experience

• Completion of medical terminology course

• Additional training may be required through formal education or through seminars.

Benefits:

• Medical, dental, vision & life insurance plans

• 403(b) retirement match contribution by Pine Rest

• Generous PTO for full and part time employees

• Tuition assistance & loan forgiveness

• Employee Assistance Program offering many free and discounted services for therapy, legal, accounting, gym membership, etc.

• Partnership with Davenport University provides generous discount on tuition for employees and family members.

Notice:

Pine Rest provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

All new employees are subject to a criminal background check and education verification which may include sending a copy of your high school diploma, GED, or college transcripts.

NOTICE: Successful completion of a drug screen prior to employment is also part of our background process.