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The stated pay scale reflects the range that Sharp reasonably expects to pay for this position. The actual pay rate and pay grade for this position will be dependent on a variety of factors, including an applicant's years of experience, unique skills and abilities, education, alignment with similar internal candidates, marketplace factors, other requirements for the position, and employer business practices.

What You Will Do
Responsible for performing coding, abstracting and sequencing of medical information for functional areas in the Sharp HealthCare system. Assures correct assignment of ICD-10-CM and CPT 4 codes for all diagnoses and procedures, including co-morbidities and complications, sequenced, and grouped (DRG's, MS-DRG's and APC's) as mandated. Uses the most accurate codes for reimbursement purposes, research, epidemiology, statistical analysis outcomes, HCAL data financial and strategic planning, evaluation of quality of care, and communication to support the patient's treatment. Maintains the confidentiality of patient records and procedures. This level of coding represents those coders who have the ability to code the most complex cases.

Required Qualifications

• H.S. Diploma or Equivalent
• Other: Formal training in ICD-9-CM and CPT coding classification.
• 3 Years hospital coding experience in each of the following coding systems: ICD-10-CM, CPT, E&M, and HCPCS.
• Certified Procedural Coder - Hospital (CPC-H) - American Academy of Professional Coders (AAPC) OR Certified Coding Specialist (CCS) - The American Health Information Management Association (AHIMA) OR Registered Health Information Administrator (RHIA) - The American Health Information Management Association (AHIMA) OR Registered Health Information Technician (RHIT) - The American Health Information Management Association (AHIMA) -REQUIRED

Preferred Qualifications

• Associate's Degree in Health Information Management.

Essential Functions

• Abstracting accuracy
  Verifies the accuracy of interfaced data in abstracts (i.e., patient type, discharge disposition, etc.) and edits when necessary to assure correct information is being accurately and completely collected.
  Assigns all applicable physician profiles as defined by Medical Staff policies.
  Collects additional data into the database for statistical, tracking and trending purposes.
  HDM system information is accurately and completely abstracted.
• Coding accuracy
  Reviews clinical information and assigns/sequences the correct principle and secondary diagnoses and procedures according to UHDDS definitions.
  Correctly identifies and assigns co-morbid and/or complication codes (cc's) to obtain the accurate severity level (DRG's, MS-DRG's and APC).
  Assures that documentation is present and complete in order to substantiate the codes and generate an accurate final bill. 
  Utilizes the 3M Encoder System to assure that all appropriate codes are captured.
• Coding compliance
  Codes according to classification systems which include ICD-10-CM, CPT and HCPCS nomenclature and Sharp HealthCare coding rules and guidelines.
  Refuses to fraudulently maximize reimbursement by assigning codes that do not conform to approved coding principles, guidelines and regulatory standards.
  Refuses to unfairly maximize reimbursement by unbundling service and codes that do not conform to ICD-10-CM and CPT basic coding principles and guidelines.
  Abides by all coding conventions, ethical and professional standard and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), and AHIMA for assignment of diagnostic and procedural codes.
  Reviews HCFA Common Procedural Coding System (HCPCS) codes to assure appropriate assignment for outpatient Medicare reimbursement.
  Reviews and verifies charges to assure an accurate and complete final bill.
• Confidentiality
  Observes and respects the confidentiality of information in regard to patients, physicians and fellow employees as stated in the policy manual.
• Productivity
  Productivity standards are based on the DNFB average monthly goal and meeting entity productivity expectations.
• Professional development
  Attends workshops and in-services in order to obtain a minimum of ten continuing education hours annually.
  Maintains active registration or accreditation status with AHIMA and/or CCS requirements, when applicable.
  Ongoing education for coding and billing as per job requirements, that includes reading literature, coding references, resources and updates.
  Contributes/Participates in team discussions pertinent to coding functions.
  Opportunities for advancement to the next coding level requires a competency examination.
• Query process
  Query Process: Contacts and interacts with physicians and hospital staff, as needed, to clarify and assure the proper coding classifications: DRG, MS-DRG and/or APC assignments.
  Episodes of care in which determination of principle and/or secondary diagnosis or documentation is not clear, the appropriate healthcare provider shall be queried and contacted by the coder.
  Contacts and verifies any unclear charges or discrepancies with appropriate ancillary services.
  Communicate with case managers and/or service line leaders regarding any documentation discrepancies.

Sharp HealthCare is an equal opportunity/affirmative action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability or any other protected class.