Job Description

Job Summary: The Inpatient & Outpatient Coder plays a vital role in ensuring accurate and timely coding of medical records for both inpatient and outpatient encounters, contributing to efficient reimbursement and optimal patient care. They maintain a 95% coding accuracy rate and current, up-to-date knowledge of coding rules and regulations. Actively and consistently contributes to department operations and communications, behaves in a manner consistent with the mission, vision, and values of Pipeline Health, upholding standards of AIDET (Acknowledge, Introduce, Duration, Explanation, Thank you) patient communication.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act.

Essential Functions:

• Assigns ICD-10CM/PCS and CPT (Current Procedural Terminology) codes using appropriate source documents within the medical record.
• Assigns ICD-10CM/PCS and CPT codes in compliance with current coding regulations.
• Completes at a minimum ten (10) Continuing Education Units (CEUs) per year.
• Assigns diagnostic and procedural codes to outpatient ancillary/recurring visits, emergency department, same day surgery or inpatient records as needed.
• Maintains an average coding accuracy rate of 95%.
• Maintains productivity rate of four (4) inpatient charts per hour and five (5) outpatient surgery charts per hour.
• Prioritizes workload volume appropriately by coding and abstracting the oldest accounts first. Codes any account with charges greater than $50,000 before the oldest accounts.
• Maintains productivity rate of 20 ER’s (Emergency Rooms), 27 ancillary, or 5 newborn records per hour.
• Abstracts data elements from discharge records onto hospital’s patient information system using state-mandated data definitions (OSHPD) with an average accuracy rate of 98%.
• Participates in timely submission of OSHPD patient data semiannually.
• Participates in correction of OSHPD discharge data edits and correction report as needed.
• Always completes daily productivity.
• Maintains an accuracy rate of 100% in assigning disposition codes on all Medicare transfer DRGs (Diagnosis-Related Groups).
• Works collaboratively with department coordinator and clerical staff in ensuring that DNFB (Discharge, Not Final Billed) is within the Corporate and Departmental guidelines of four (4) days or less from date of discharge.
• Ensures that all reports relative to performance improvement for the coding functions are timely.
• Uses clear, concise, professional communication with coworkers, patients, all customers internal and external.
• Uses AIDET in interactions with patients and family members.
• Acts with a sense of urgency when performing tasks.
• Basic unit/department maintenance such as keeping files, drawers, cabinets free from unnecessary clutter.
• Reports on any equipment and or environmental issues for repair.
• Abides by HIPAA (Health Insurance Portability and Accountability Act) regulations.
• Speaks up to stop the line and escalates potential safety events if necessary.
• Completes and attends monthly training assigned.
• Other duties as assigned.

Behavioral Standards:

• Treats everyone as their customer; utilizes scripting and other tools to ensure consistency in customer service; Expresses recognition and shows appreciation to others; fully utilizes AIDET principles; responds quickly to handle requests, complaints, and questions; displays a positive attitude.
• Demonstrates the highest level of professionalism, passion and care when interacting with patients, families, physicians, and hospital staff members.
• Using a lens of equity in all aspects of patient care delivery, education, and research to promote policies and practices to allow opportunities for all to thrive and reach their potential, embracing ingenuity to service our customers.

Communication/Knowledge:

• Wears nametag properly; follows dress code policy; answers phone correctly and promptly; is prepared for meetings; meets deadlines; does not participate in gossip; acts ethically and treats others with respect; respects customer’s and co-worker’s time; establishes and maintains effective relationships with customers and co-workers.

Collaboration/Teamwork:

• Attends staff meetings; follows HIPAA guidelines; follows patient rights policy; complies with the compliance program; demonstrates knowledge of role in a disaster; demonstrates knowledge of fire and fire drill procedures; working knowledge of hospital emergency codes; always utilizes standard precautions in the clinical setting; safely manages the environment of care by demonstrating a working knowledge of the requirements of the: Life Safety program, Utilities Management program, Hazardous Materials program, Emergency Preparedness program, Safety Management program, Medical Equipment Management program, Security Management program.

Qualifications/Experience:

• Minimum 2-years of experience in an acute care or inpatient setting.
• Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, strong organizational skills, ability to follow verbal instructions, and PC (computer) skills.
• A capacity to learn, synthesize, make critical judgments, work independently, place patients and families first, and collaborate with the team members who are recognized leaders within health care.