Medical Records Coder Full Time Days
About Steward Health Care
Nearly a decade ago, Steward Health Care System emerged as a different kind of health care company designed to usher in a new era of wellness. One that provides our patients better, more proactive care at a sustainable cost, our providers unrivaled coordination of care, and our communities greater prosperity and stability.
As the country’s largest physician-led, tax paying, integrated health care system, our doctors can be certain that we share their interests and those of their patients. Together we are on a mission to revolutionize the way health care is delivered - creating healthier lives, thriving communities and a better world.
Steward is among the nation’s largest and most successful accountable care organizations (ACO), with more than 5,500 providers and 43,000 health care professionals who care for 12.3 million patients a year through a closely integrated network of hospitals, multispecialty medical groups, urgent care centers, skilled nursing facilities and behavioral health centers.
Based in Dallas, Steward currently operates 39 hospitals across Arizona, Arkansas, Florida, Louisiana, Massachusetts, Ohio, Pennsylvania, Texas, and Utah.
For more information, visit www.steward.org.
***Medical Records Coder 40hrs/Days
Reviews hospital medical records and/or reports to determine all diagnoses and procedures; assigns the correct ICD10-CM and/or CPT code; adheres to accepted coding conventions; accurately inputs information into Meditech for purposes of reimbursement and clinical and financial decision making
Reads and interprets health record documentation to identify all diagnoses and procedures that affect the inpatient/outpatient stay/visit
Assesses the adequacy of health record documentation to ensure that it supports all diagnoses and procedures to which codes are assigned
Applies knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to assign accurate codes to diagnoses and procedures
Applies knowledge of current approved coding guidelines (as published in Coding Clinic for ICD10-CM) to assign and sequence the correct diagnosis and procedure codes for hospital inpatient services with a 95% accuracy rate
Applies knowledge of current coding guidelines and regulatory agency guidelines to assign the correct diagnosis and procedure codes for hospital outpatient services with a 95% accuracy rate
Applies knowledge of CPT format, guidelines and notes to locate the correct codes for all services and procedures performed during the encounter/visit and sequence them correctly
Applies Uniform Hospital Discharge Data Set (UHDDS) definitions to select the principal diagnosis, principal procedure, complications and cormorbid conditions, and other diagnoses and significant procedures which require coding
Applies knowledge of the Prospective Payment System to confirm DRG assignment which ensures optimal reimbursement
Refuses to fraudulently maximize reimbursement by assigning codes that do not conform to approved coding principles/guidelines
Applies knowledge of the Outpatient Prospective Payment System to confirm APC/APG assignment which ensures optimal reimbursement
Applies knowledge of ICD10-CM instructional notations and conventions to locate and assign the correct diagnostic and procedural codes and sequence them correctly
Attaches modifiers to procedure or service codes when applicable
Accurately codes for the professional vs. technical component when needed
Clarifies conflicting, ambiguous, or nonspecific information appearing in the record by consulting the appropriate physician
Participates in quality assessment to ensure continuous improvement in ICD10-CM and CPT coding and collection of quality health data
Demonstrates the ability to recognize potential coding quality issues from an array of data
Accurately enters data into Meditech, verifying any existing information
REQUIRED KNOWLEDGE & SKILLS:
Two to four years coding experience in a health care setting
Working knowledge of ICD10-CM and CPT-4 coding systems
Certified Coding Specialist or Accredited Health Information Technician credentials preferred
Inpatient coding experience preferred
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Important COVID message
Please note, Morton Hospital is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence and convenience: Expanded hours will allow previously cancelled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their families. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy has been implemented throughout the hospital. A strictly controlled visitor and masking policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.
This position is subject to the COVID-19 Vaccination Policy for Steward Health Care Workforce. Employees in this position will be required to provide adequate proof of vaccination for COVID-19 by an FDA-approved vaccine prior to starting work. Steward will consider requests for exemptions from this vaccine requirement on the basis of medical condition or sincerely held religious belief in accordance with applicable Federal laws.
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Job Status: Full Time
Job Reference #: 123514