Job Summary Performs all coding and abstracting for HUP, PPMC and PAH, by reviewing medical records and selecting the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures accurately. Performs analysis of the DRG assigned to produce the highest level of reimbursement to which the facility is legally entitled according to stringent coding and compliance guidelines.
Reviews and acts as the gatekeeper for the provider query process, by being the single point of contact with the provider community. Assigns high dollar and death charts to the coding staff in a fair and equitable manner. Performs inpatient SMART reviews adhering to national and facility specific coding guidelines.
Assists Coding Managers with other duties, as assigned. Accountabilities Examines the complete medical record to accurately determine the principal & secondary diagnoses, procedures, co-morbidities and complications demonstrating 96% accuracy as determined by audits.
Sequence the diagnoses & procedures to obtain the optimal DRG or APR-DRG assignment and demonstrates 96% accuracy as determined by monthly audits.
Simultaneously abstracts and enters all coded information into the Pennchart/EPIC system for timely billing. This includes the correct discharge disposition verified through the Case Management Department Consistently codes the oldest cases first and prioritizes high dollar cases over 4 days old first. Demonstrates a consistent level of performance; strives to maintain a steady level of productivity according to the following guidelines: o HUP Average of 15 inpatient records coded daily o PPMC Average of 15 inpatient records coded daily o PAH Average of 19 inpatient med/surg charts or 22.5 OB/NB inpatient records coded daily Refers charts that require clarification of vague or unclear documentation for accurate coding and DRG assignment to a Coding Quality Specialist to query the physician for the needed documentation.
Promptly and accurately assigns Coding Hold reasons to all records that cannot be completed immediately due to: o Missing Operative Notes o Missing Pathology Report o Physician Query Needed o Death Review o Discharge Disposition o Missing Other Reports (Card Cath, EPS, etc) Correctly identifies and applies Present on Admission indicators to all applicable diagnoses according to designated guidelines.
Accuracy is important due to the far reaching impact on reimbursement and quality metrics. Reviews and processes provider queries.
This includes working with the coding staff to appropriately write the query as well as communicating with the provider community to ensure the query is answered. Assigns high dollar and death charts to the coding staff in an equitable manner. Performs revenue cycle/DNFB activities, as needed.
Performs inpatient SMART reviews. This includes communicating with the staff in a professional manner and providing Coding Clinic or clinical information when required. Maintains professional credentials by continuing education both inside and outside the organization and tracks continuing education credits. Performs duties in accordance with Penn Medicine and entity values, policies, and procedures Other duties as assigned to support the unit, department, entity, and health system organization
University Of Pennsylvania Health System