Department: Medical Records

Schedule: Full Time, 40 Hours, Days

Facility: Central Maine Medical Center

Location: Lewiston, Maine, 04240

Central Maine Healthcare (CMH), a member of Prime Healthcare Foundation, is an integrated healthcare delivery system serving approximately 400,000 residents across central, western, and midcoast Maine through a network of more than 40 primary and specialty care locations. The system includes Central Maine Medical Center  (CMMC) in Lewiston, a 250-bed, not-for-profit regional referral hospital that is home to the region's only Cancer Care Center, an orthopedic ambulatory surgery center, and the Central Maine Heart and Vascular Institute. CMMC also serves as the central Maine base for LifeFlight of Maine, the state's only medical helicopter service.

CMH also includes Bridgton Hospital and Rumford Hospital, two 25-bed critical access hospitals that provide essential care to Maine's rural communities.

As part of its commitment to healthcare education and workforce development, CMH is home to the Maine College of Health Professions, Maine's first nursing and medical imaging school. The private, not-for-profit institution is accredited by the New England Commission of Higher Education and plays an important role in training the next generation of healthcare professionals.

To learn more, visit www.cmhc.org.

The Coder I reviews and analyzes documentation present in the medical record for both inpatient and outpatient visits to determine diagnoses and procedures as described by the physicians of record. Utilizing the International Classifications of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT), the Coder I translates the documented diagnosis and procedural information into coded data. Determination of code assignment is based on the official American Health Association (AHA) guidelines in addition to hospital specific and regulatory guidelines. The Coder I enters the coded data and other abstracted data from the medical record into hospital's electronic information system, facilitating the Health Information Services department's indexing responsibility for internal use (such as to support medical care evaluation studies), and mandated reporting requirements. Participates in chart review projects as assigned.

1. Minimum one year experience with ICD-9 and CPT coding in an acute care setting; required.
2. Basic computer experience; required.
3. Use of an encoder software product for code assignment in an acute care setting; preferred.
4. Computer data entry with 10-key preferred, with accurate typing speed of 35 wpm; preferred.
5. Successful completion of college level courses in anatomy, physiology, medical terminology, and coding ICD and CPT; required.
6. Successful completion of or current enrollment in a program for certification as a Certified Coding Specialist (C.C.S.), Registered Health Information Technician (R.H.I.T.), or Registered Health Information Administrator (R.H.I.A.); required.
7. Certification or license as a Certified Coding Specialist (C.C.S.), Registered Health Information Technician (R.H.I.T.), or Registered Health Information Administrator (R.H.I.A.); preferred.

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