HIM Specialty Coder II

The HIM Specialty Coder II is responsible for accurately reviewing, coding, and abstracting patient medical records to ensure the proper coding of diagnoses, procedures, and services for billing and reimbursement purposes. The role demands advanced knowledge in coding and reimbursement methodologies, a deep understanding of compliance regulations, and the ability to manage complex coding scenarios across multiple specialties. This position is critical to safeguarding the financial integrity of Billings Clinic by ensuring adherence to coding standards and maximizing appropriate reimbursement.

Essential Job Functions

• Reviews and analyzes inpatient, outpatient, and professional medical records to accurately identify principal and secondary diagnoses, procedures, and services
• Assigns appropriate ICD-CM, ICD-PCS, CPT, and HCPCS codes in accordance with official coding guidelines, payer requirements, and Billings Clinic policies
• Utilizes computerized encoding systems and approved reference materials to ensure accurate code selection, sequencing, and compliance
• Calculates and validates Diagnosis-Related Groups (DRGs) and Ambulatory Payment Classifications (APCs) to support accurate, ethical reimbursement
• Assigns Present on Admission (POA) indicators accurately for inpatient encounters
• Identifies and captures missing or incomplete charges and documentation to support appropriate billing
• Ensures coded data accuracy prior to billing interface and claims submission, including discharge disposition, modifiers, performing provider, date of service, and payer-specific edits
• Maintains a minimum of 95% coding accuracy based on internal and external audit findings
• Meets or exceeds established departmental productivity standards for assigned coding areas
• Identifies, documents, and promptly escalates potential coding, billing, or compliance concerns to leadership or the Corporate Compliance Department
• Initiates compliant provider queries to clarify documentation and support accurate code assignment
• Collects and abstracts required clinical and demographic data for discharge reporting, audits, and specialized studies
• Communicates professionally with physicians and non-physician providers to provide coding clarification, education, and feedback
• Maintains current knowledge of coding guidelines, reimbursement methodologies, and regulatory requirements through ongoing education and training
• Demonstrates compliance with all organizational, departmental, safety, confidentiality, and patient privacy standards
• Supports and models behaviors consistent with Billings Clinic's mission, vision, values, code of business conduct and service expectations. Meets all mandatory organizational and departmental requirements. Maintains competency in all organizational, departmental and outside agency standards as it relates to the environment, employee, patient safety or job performance.
• Performs all other duties as assigned or as needed to meet the needs of the department/organization.

Minimum Qualifications

Education

• High school graduate or equivalent
• Prior formal training in anatomy, medical terminology, and medical coding.

Experience

• Two (2) years of coding experience with multiple specialties and basic reimbursement experience
• Two (2) years of coding experience with all patient types and all third-party and government payers.

Certifications and Licenses

• Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) or Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) At hire or other AHIMA and/or AAPC recognized certification pertinent to the position
• Specialty certification (e.g., CCS, RCC, ROCC) in addition to core coding credentials within 6 months of hire

Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.