Job Description

Description

Eastern Plumas Health Care is a non-profit, critical access hospital district, providing comprehensive medical services to Plumas County since 1971. We operate a 9 bed acute care hospital at our main Portola campus, which includes a 24 hour, physician staffed, emergency room and ambulance service. In addition, four primary care medical clinics and a dental clinic offer residents a full spectrum of health care services in the Graeagle, Loyalton, and Portola communities. There are also hospital-based Skilled Nursing Facilities in Portola and Loyalton.

Surrounded by the Sierra Nevada Mountains with beautiful lakes and trails for hiking, biking, fishing and skiing, this facility is thriving and wants a highly motivated and experienced HIM Coder. 

Job Summary: 

Evaluates medical records, provides clinical abstracts and assigns appropriate clinical diagnosis and procedure codes in accordance with nationally recognized coding guidelines. The coding classification systems include ICD 10 CM, PCS, CPT and HCPSC. Enters billing codes for all patient classes, and assist with maintenance of the Master Patient Index. Must have the ability to work independently.        

Essential Functions

  • Analyzes medical information from medical records. Accurately codes diagnostic and procedural information in accordance with national coding guidelines and appropriate reimbursement requirements. Consults with medical providers to clarify missing or inadequate record information and to determine appropriate diagnostic and procedure codes (Physician Queries). Provides thorough, timely and accurate assignments of ICD-10 CM and PCS and/or CPT codes, POAs and reconciliation of charges. Make the necessary charge corrections and/or additions as well as flagging accounts for deficiencies including follow-up and completion per established guidelines.
  • Abstracts clinical diagnoses, procedure codes and documents other pertinent information obtained from the electronic medical records. Seeks out missing information and creates complete records, including items such as disease and procedure codes, point of origin code, discharge disposition, date of surgery, attending physician, consulting physicians, surgeons and anesthesiologists, and appropriate signatures/authorizations. Refers inconsistent patient treatment information/documentation to coding quality analysis, supervisor or individual department for clarification/additional information for accurate code assignment. Accuracy is required for OSHPD report requirements.
  • Provides quality assurance for medical records. For all assigned records and/or areas assures compliance with coding rules and regulations according to regulatory agencies for state Medicaid plans, Center for Medicare Services (CMS), Office of the Inspector General (OIG) and the Health Care Financing Administration (HCFA), as well as company and applicable professional standards.
  • As assigned, compiles daily and monthly reports for OSHPD and SIERA reporting; tabulates data from medical records for research or analysis purposes. Responds to telephone and walk-in customers requesting release of information in a prompt and professional manner.
  • As set forth in the Health Insurance Portability & Accountability Act of 1996 (HIPAA) the incumbent will maintain patient confidentiality in accordance with State and Federal regulations. Protected health information (PHI) is restricted on a need to know basis. Scan additional documentation into patients chart from internal and external sources. Maintain secondary data base for Long Term Care unit with patient diagnoses, review chart for additional documentation to support coding and billing.

Minimum Qualifications

  • High school diploma/GED or equivalent working knowledge and specialized formal training equivalent to the two year certification course in medical record keeping principles and practices, anatomy, physiology, pathology, medical terminology, standard nomenclature, and classification of diagnoses and operations, or an Associate’s Degree in a related health care field.
  • Must demonstrate a level of knowledge and understanding of ICD-10CM and PCS and CPT coding principles as recommended by the American Health Information Management Association (AHIMA) coding competencies, and as normally demonstrated by certification by the American Academy of Professional Coders (AAPC). Six months providing coding services within a broad range of health care facilities, ability to test and successfully pass certification testing within six months of employment. Must be able to achieve an acceptable accuracy rate on the coding test administered by the hiring facility according to pre-established company standards.
  • Must be able to work effectively with common office software, coding software, and abstracting systems.

Preferred Qualifications

  • Certified Coding Associate (CCA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC) in an active status or Certified Coding Specialist-Physician (CCS-P) with American Health Information Management Association (AHIMA) or American Academy of Professional (AAPC) Coders is preferred. Must keep certification current and in good standing with certify board. Will consider experience in lieu of certification/degree. Additional related education and/or experience preferred.