Coder, Lead Health Information Management - HIM Financial - Full Time 8 Hour Days (Non-Exempt) (Non-Union)

Assists the HIM coding supervisor by providing daily DNFB/DNFC oversight over all 'Outpatient Ancillary/Clinic Visits' coding operations. Provide coding liaison functionalities between HIM Coding and Patient Financial Services (PFS) on denial management coding related edits, items, and issues. Perform IP & OP coding auditing functions. In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding department related duties as assigned by HIM management staff.

Essential Duties:

• Assist the coding director/supervisor with the daily monitoring of the OP Ancillary/Clinic/OCOH coding activities.
• Ability to provide feedback & input to the coding director/supervisor regarding scheduling of staff according to section needs.
• Assist the coding director/supervisor with generating & maintenance of daily HIM Coding Dept. report & statistics associated with productivity, daily inflows, DNFB, DNFC, pending, on-hold, and issues accounts.
• Ability to implement and monitor policies and procedures by effectively working with the OP Ancillary/Clinic/OCOH coding team.
• Monitor Cerner & HDM coding queues/task worklists to ensure consistent coding of pending and on-hold accounts.
• Performs monthly internal coding audits to evaluate accuracy of coding staff to ensure a 95% coding accuracy rate.
• Develops monitoring/education plans for coding staff who do not meet the 95% accuracy rate.
• Recognizes education needs of staff based on monthly reviews and conducts related in-services, as needed.
• Ability to act as a resource to coding and hospital staff on coding issues and questions.
• Ability to achieve a 95% accuracy rate as determined by an annual external review of coding.
• Inpatient coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.
• Reviews the entire medical record; accurately classify and sequence diagnoses and procedures; ensure the capture of all documented conditions that coexist at the time of the encounter/visit, all medical necessity diagnoses, complications, co-morbidities, historical condition or family history that has an impact on current care or influences treatment, and all external causes of morbidity.
• Enter patient information into inpatient and outpatient medical record databases (ClinTrac/HDM). Ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements prior to billing interface and claims submission.
• Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.
• Assists in the correction of regulatory reports, such as OSHPD, as requested.
• Attendance, punctuality, and professionalism in all HIM Coding and work related activities.
• Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions. Completes tasks accurately, legibly, and in a timely fashion.
• Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.
• Ability to achieve a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).
• Ability to achieve a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).
• Assist in ensuring that all medical records contain information necessary for optimal and accurate coding and abstracting.
• Recognizes education needs of based on monthly reviews and conducts self-improvement activities.
• Ability to act as a resource to coding and hospital staff on coding issues and questions.
• Ability to improve MS-DRG assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Ability to improve APR-DRG, SOI, and ROM assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Ability to improve APC/HCC assignments based on medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.
• Maintains at minimum, expected productivity standards (See HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.
• Works coding queues/task lists to ensure 95% of patient bills are dropped within 5 days after patient discharge/date of service.
• Works coding queues/task lists to ensures the remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.
• Assist other coders in performance of duties including answering questions and providing guidance, as necessary.
• Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and/or providing information so that an interim bill can be generated. Assists with physicians, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed.
• Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority.
• Maintains AHIMA and or AAPC coding credential(s) specified in the job description.
• Attend coding & CDI seminars, webinars, and in-services to maintain the required annual continued education units (CEU).
• Keep up-to-date and reviews ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, and CPT Assistant to maintain knowledge of the principles of coding.
• Keep up-to-date and reviews other professional journals and newsletters in a timely fashion to maintain knowledge of the principles of coding.
• Consistently attend and actively participate in the daily huddles.
• Consistently adhere to HIM policies and procedures as directed by HIM management.
• Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed.
• Participates in continuously assessing and improving departmental performance.
• Ability to communicate changes to improve processes to the director, as needed.
• Assists in department and section quality improvement activities and processes (i.e. Performance Improvement).
• Works and communicates in a positive manner with management and supervisory staff, medical staff, co-workers and other healthcare personnel.
• Ability to communicate effectively intra-departmentally and inter-departmentally.
• Ability to communicate effectively with external customers.
• Provides timely follow-up with both written and verbal requests for information, including voice mail and email.
• Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage.
• Working knowledge, efficient navigation, & full use of 3M-CRS Encoder system; utilize to expedite coding process; utilize all references.
• Knowledge & understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac.
• Working knowledge, efficient navigation, & full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software.
• Working knowledge, efficient navigation, & full use of ‘3M 360 Encompass/CAC’.
• Performs other duties as assigned.

Required Qualifications:

• Req High school or equivalent
• Req Specialized/technical training Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding course. Successful completion of the hospital specific coding test – with a passing score of ≥85%. The coding test may be waived for former USC or agency/contract HIM Coding Dept. coders who historically/previously met the ≥ 90% internal/external audit standards of the previously held USC Job Code.

• Req 3 years Experience in ICD-9 & ICD-10 (combined) coding of inpatient medical records in an acute care facility and experience in using a computerized coding & abstracting software and an encoding/code-finder database systems

• Req Working knowledge of CPT-4 and ICD-9CM coding and computerized billing systems such as IDX.
• Req Knowledge of medical terminology.
• Req Leading/ guidance skills
• Req Organization/time management skills.
• Req Demonstrates ability to utilize effective, appropriate and diplomatic oral and written communication skills.
• Req Able to function independently and as a member of a team.

Preferred Qualifications:

Required Licenses/Certifications:

• Req Certified Coding Specialist - CCS (AHIMA) OR AAPC Certified Inpatient Coder (CIC) OR either the CCS or CIC with any one of the following national HIM certifications: 1. AHIMA Registered Health Information Technician (RHIT) 2. AHIMA Registered Health Information Administrator (RHIA)
• Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)

The hourly rate range for this position is $39.00 - $63.95. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.