CentraState Healthcare System

  • HIM Inpatient Coder

    Posted Date 3 weeks ago(3 weeks ago)
    Position Type
    Regular Full-Time
    CentraState Medical Center
    Work Schedule
  • Overview

    Identifies and sequences all diagnoses and procedures.


    • Identifies and sequences all diagnoses and procedures.
    • Assigns ICD-10-CM and CPT-4 codes and assigns a final DRG to all inpatient medical records at the time of discharge.
    • Reviews inpatient and outpatient records to ensure complete and accurate documentation to support all diagnoses and procedures and follows-up until all documentation is received.
    • Accurately abstracts required data such as discharge dispositions, consultations and procedure/operative information.
    • In a 7.5 hour day, completes an average of 22-25 inpatient records, 50 surgical records, or 100 ED records.
    • Inserts appropriate staging forms into medical records of newly diagnosed cancer patients.
    • Uses Computer Assisted Coding as a tool to accurately code diagnoses and procedures.
    • Reviews Risk of Mortality and Severity of Illness indicators and appropriately abstracts data for Clinical Documentation Improvement.


    • High School Diploma Or Equivalent
    • 1 year Medical Records Coding

    • CCS required.

    • Medical record coding knowledge including analysis and abstracting. Strong professional, organizational, and interpersonal skills to effectively relate with all members of the healthcare team.


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