HIM Coder – CCS Required

This is a fully remote position, open to applicants in New Jersey.

📋 Description

• Responsible for coding and abstracting hospital medical records for both diagnostic and procedural purposes.

• Applies federal and state procedures/guidelines to ensure the accuracy of coding, abstracting, and productivity standards.

• Works collaboratively with medical staff and clinical documentation improvement (CDI) personnel to clarify any documentation issues.

• Adheres to corporate compliance requirements regarding the coding and abstracting of medical records, including Diagnosis Related Group (DRG) assignments.

• Carefully reviews each record and employs ICD-10-CM, ICD-10-PCS, CPT-4, and encoders to accurately code all significant diagnoses and procedures.

• Properly sequences principal diagnoses and procedures based on the documentation in medical records and UHDDS definitions.

• Utilizes ongoing knowledge and reference materials concerning DRGs to confirm DRG assignments.

• Accurately applies written federal and state regulations and guidelines to ensure database uniformity.

• Confirms and/or abstracts necessary data into the computer system according to established procedures.

• Engages in efforts to meet DNB and accounts receivable goals.

• Maintains competencies at the departmental level.

• Involved in performance improvement initiatives.

⛳️ Requirements

• A minimum of two years of inpatient records coding experience or an equivalent background.

• Proficient in performing functions within a Microsoft Windows environment.

• Attention to detail and the ability to execute tasks with a high level of accuracy.

• Capable of making sound decisions.

• Strong communication and teamwork skills are essential.

• Prior experience with an electronic legal health record system is preferred.

• High School Diploma or GED is required.

• Knowledge of Anatomy & Physiology/Medical terminology is essential.

• Coding education is preferred, or equivalent experience is acceptable.

🏝️ Benefits

• Medical/prescription, dental, and vision insurance.

• Health and dependent care flexible spending accounts.

• 403(b) (401(k) subject to collective bargaining agreement).

• Paid time off.

• Paid sick leave in accordance with state and local paid sick leave laws.

• Short-term disability and optional long-term disability coverage.

• Colleague and dependent life insurance, along with supplemental life and AD&D insurance.

• Tuition assistance.

• Employee assistance program that includes free counseling sessions.