Coding Specialist - Telecommute

Responsibilities

• Enters coded abstracted information into 3M 360 Finder assigning accurate APC and reviewing all coding edits appearing in 3M.
• Understands and follows all National Correct Code Initiative Edits (NCCI) and follows pertinent medical necessity requirements.
• Resolves accounts on the claims edit database.
• Sets injections and infusion codes for observation patients.
• Maintains the minimum productivity standard maintaining an average accuracy rating of 95%.
• Sets E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits ensuring medical record documentation supports the code.
• Ensures physicians' entered diagnosis, ICD, or CPT codes are accurate and supported by documentation in the medical record.
• Utilizes 3M to identify and resolve NCCI edits before final billing.
• Reports documentation insufficiencies to the responsible physician.
• Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients less than 18 years of age.
• Maintains and resolves rejected accounts on the Claims Edit Report and eClinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity, and various other coding and billing issues.
• Refers complex coding issues to the coding validator or supervisor.
• Reviews pertinent outpatient uncoded reports researching and resolving old uncoded accounts and any accounts posted on report for which the charges are inappropriate.
• Updates patient financial accounts in the Patient Management and Patient Accounting billing system as required.
• Follows established procedures for rebilling accounts.
• Performs related clerical duties as required.

Qualifications

• BASIC KNOWLEDGE: High school diploma or equivalent. Successful completion of formal coding educational program. Ability to read and understand outpatient clinic medical record documentation for reporting of outpatient clinic, ancillary, and endoscopies. Coding certification required from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
• EXPERIENCE: One to two years experience in outpatient coding or billing. Ability to meet and maintain established quality and productivity standards.