Inpatient Coder

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The Department of HIM has an exciting opportunity for a Full-Time Inpatient Coder to work at the UHealth Towers. Under the general direction of the Inpatient Coding Manager, the Inpatient Coder I reviews documentation in the electronic medical record (EMR) and assigns and sequences ICD-10-CM diagnosis codes and ICD-10-PCS procedure codes in accordance with national coding guidelines. The primary focus of this role is to capture all encounter-specific diagnoses and procedure codes for accurate reimbursement, data collection, and research purposes.

• Reviews, analyzes, and interprets the entire electronic medical record (EMR) to identify all diagnoses and procedures documented during a patient’s admission.

• Determines and assigns the principal diagnosis and all significant secondary ICD-10-CM diagnosis codes, in addition to Present on Admission (POA) indicators and ICD-10-PCS procedure codes, using official coding guidelines and knowledge of anatomy and physiology, medical terminology, and disease processes.

• Identifies cases with clinical indicators that require provider documentation, clarification, and/or specificity to accurately assign codes; collaborates with the Clinical Care Transformation (CDI) team as part of the clinical documentation validation and physician query workflow.

• Analyzes and sequences codes in compliance with ICD-10 official coding guidelines, Uniform Hospital Discharge Data Set (UHDDS), and other regulatory requirements to assure proper Medicare Severity Diagnostic Related Groups (MS-DRG) assignment.

• Reviews medical record documentation for major complications and comorbidities (MCC), complications and comorbidities (CC), severity of illness (SOI), and risk of mortality (ROM).

• Maintains coding accuracy and productivity standards of ≥ 95%.

• Adheres to University and unit-level policies and procedures and safeguards University assets.

This list of duties and responsibilities is not intended to be all-inclusive and may be expanded to include other duties or responsibilities as necessary.

MINIMUM QUALIFICATIONS 

• High School Diploma or equivalent.

• Graduate of an accredited Health Information Technology or Coding program.

• Minimum 2 years of current ICD-10 acute care facility coding experience.  

• Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), and/or Registered Health Information Administrator (RHIA).

• Skill in completing assignments accurately and with attention to detail.

• Ability to analyze, organize, and prioritize workload while consistently meeting ≥ 95% productivity and accuracy standards.

• Understanding of and adherence to the Health Insurance Portability and Accountability Act (HIPAA).

• Commitment to the University of Miami Health System policies and procedures.

• Must stay up to date with continuing education requirements to maintain credentials.

• Ability to work independently and/or in a collaborative environment.

• Strong background in use of encoder, computer assisted coding, and EMR software applications.

• Efficient communication skills (interpersonal, verbal, and written).

• Strong organizational and analytical skills.

• Critical thinking skills and ability to interpret, assess, and evaluate provider documentation.

• Proficient with Microsoft Office applications.

• Ability to sit for long periods of time.

• Capable of working in a 100% remote environment with little supervision, while also staying focused on assignment tasks.

​Any appropriate combination of relevant education, experience and/or certifications may be considered.

The University of Miami offers competitive salaries and a comprehensive benefits package including medical, dental, tuition remission and more.

UHealth-University of Miami Health System, South Florida’s only university-based health system, provides leading-edge patient care powered by the ground breaking research and medical education at the Miller School of Medicine. As an academic medical center, we are proud to serve South Florida, Latin America and the Caribbean. Our physicians represent more than 100 specialties and sub-specialties, and have more than one million patient encounters each year. Our tradition of excellence has earned worldwide recognition for outstanding teaching, research and patient care. We’re the challenge you’ve been looking for.

Patient safety is a top priority. As a result, during the Influenza (“the flu”) season (September through April), the University Of Miami Miller School Of Medicine requires all employees who provide ongoing services to patients, work in a location (all Hospitals and clinics) where patient care is provided, or work in patient care or clinical care areas, to have an annual influenza vaccination. Failure to meet this requirement will result in rescinding or termination of employment.

The University of Miami is an Equal Opportunity Employer – Females/Minorities/Protected Veterans/Individuals with Disabilities are encouraged to apply. Applicants and employees are protected from discrimination based on certain categories protected by Federal law. Click here for additional information.

Job Status:

Full time

Employee Type:

Staff

Pay Grade:

c105