Coder II

About the role

The Coder II under general supervision of the Director provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services.

Responsibilities

• Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments
• Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes
• Concurrently codes Recurring records for interim billing
• Processes records for deficiencies and return for completion
• Enters codes into the Abstracting Module as needed, including use of the 3M encoder
• Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure compliance with all APC mandates and outpatient reporting requirements
• Maintains the quality of clinical documentation to spot incomplete or inconsistent documentation for outpatient encounters that impact the code selection and resulting APC groups and payment
• Evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for outpatient encounters that impact the code selection and resulting APC groups and payment
• Brings identified concerns to medical staff, nursing, or department managers for resolution
• Provides training of facility healthcare professionals use of coding guidelines and practices, proper documentation techniques as needed for outpatient reimbursement
• Investigates, monitors and develops reports for studies involving outpatient encounter data for clinical evaluation purposes and/or financial impact
• Demonstrates competence in the use of computer applications and APC Grouper Software, OCE edits, and all coding and abstracting software and hardware currently in use
• Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster
• Maintains established department policies, procedures, objectives, quality assurance, safety environmental and infection control
• Enhances professional growth and development through in-service meetings, education programs, conferences, workshops, etc

Requirements

• Education: Associates degree in a health information services discipline required
• Experience: None required
• Licenses/Certifications: AHIMA RHIA, RHIT or Certified Coding Specialist (CCS) required
• Skills: Excellent computer skills. Strong training background in coding and reimbursement. Ability to apply official coding guidelines.

Physical Demands and Working Conditions

• Frequent: sitting, standing, walking, & reaching
• Occasional: lifting, carrying, bending, & squatting
• Visual and hearing acuity required
• Possible exposure to: toxic/caustic chemicals or detergents, communicable diseases, blood borne pathogens