Coding Specialist II

WE ARE INSIGHT : At Insight Hospital and Medical Center Chicago,  we believe there is a better way to provide quality healthcare while achieving health equity. Our Chicago location looks forward to working closely with our neighbors and residents, to build a full-service community hospital in the Bronzeville area of Chicago; creating a comprehensive plan to increase services and meet community needs. With a growing team that is dedicated to delivering world-class service to everyone we meet, it is our mission to deliver the most compassionate, loving, expert, and impactful care in the world to our patients. Be a part of the Insight Chicago team that provides PATIENT CARE SECOND TO NONE! If you would like to be a part of our future team, please apply now! GENERAL SUMMARY : Analyzes physician / provider documentation contained in assigned Emergency Department (ED) and Outpatient Observation health records (electronic, paper or hybrid) to determine the principal diagnosis, secondary diagnoses, principal procedure and secondary procedures. Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of International Classification of Diseases, Clinical Modification (ICD-CM) diagnosis and procedure codes, and Current Procedural Terminology (CPT) / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers. Duties and Responsibilities :

• Assigns appropriate code(s) by utilizing coding guidelines established by :
• The Centers for Medicare / Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting
• American Hospital Association (AHA) Coding Clinic for International Classification of Diseases, Clinical Modification
• American Medical Association (AMA) CPT Assistant for CPT codes
• American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Insight Hospital coding policies
• Knows, understands, incorporates, and demonstrates the Insight Hospital in behaviors, practices, and decisions.
• Adheres to Insight Hospital confidentiality requirements as they relate to the release of any individual or aggregate patient information.
• Proficiently navigates the patient health record and other computer systems / sources in determination of diagnoses procedures and modifiers to be coded and / or for APC assignment.
• Codes Emergency Department and Outpatient Observation utilizing encoder software and online tools and references, in the assignment of ICD, CPT, and HCPCS codes and modifiers.
• Consults reference materials to facilitate code assignment.
• Understands appropriate link of diagnosis to procedure.
• Appends modifier(s) to procedure code or service when applicable.
• Collaborates with HIM and Patient Financial Services) in resolving billing and utilization issues affecting reimbursement.
• Interprets bundling and unbundling guidelines (NCCI).
• Interprets LCDs / NCDs and payer policies.
• Tracks issues (., missing documentation or charges) that require follow-up to facilitate coding in a timely fashion.
• Investigates claims denials and / or appeals as directed.
• Consistently meets or exceeds coding quality and productivity standards.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Identifies concerns and is responsible for providing resolution of moderate to complex problems. Notifies appropriate leadership for resolution when appropriate.
• Performs other duties as assigned by Leadership.
• Maintains a working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Compliance Accountability Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

REQUIRED KNOWLEDGE, SKILLS AND ABILITIES :

PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS :

BENEFITS :

Insight Employees are required to be vaccinated for COVID-19 as a condition of employment, subject to accommodation for medical or sincerely held religious beliefs.