Lead Certified Outpatient Hospital/Facility Coding Specialist

About the Role

Responsible for primary diagnosis and procedural coding for designated ambulatory and hospital outpatient settings. Proficiently assigns proper and accurate medical codes for diagnosis, procedures, and services performed in an outpatient setting, such as the emergency department, outpatient clinic, same day surgery, or diagnostic testing (radiology and laboratory). Typically reports to the Coding Manager.

Qualifications

• High School Diploma or GED required; Associate’s degree in Health Information Management or any Healthcare Related Field preferred.
• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or relevant Coding Certification(s) from American Health Information Management Association (AHIMA) or American Association of Professional Coders (AAPC) required.
• Six (6) years of hospital outpatient or ambulatory coding experience.
• Experience coding in a Level 1 trauma facility/academic teaching facility preferred.
• Strong knowledge of ICD-10-CM and/or CPT coding, human anatomy, physiology, medical terminology, and surgical terminology.
• Analytical skills necessary to interpret data in health records and assign appropriate codes.
• Effective oral and written communication skills.
• Critical thinking, good judgment, and decision-making skills.
• Knowledge of coding compliance policies, official coding guidelines, regulatory requirements, and internal policies and procedures affecting the coding process.
• Proficient in navigating a Windows-based application environment.

Responsibilities

• Reviews medical record documentation to identify pertinent diagnosis/procedures that require code assignment for outpatient records and accurately code the diagnoses and procedures using ICD-10 coding conventions for reimbursement, research, and compliance with federal regulations.
• Reviews the medical record to assure specificity of diagnoses, procedures, and appropriate reimbursement for hospital and professional charges.
• Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Keeps abreast of coding guidelines and reimbursement reporting guidelines and brings identified concerns to the manager for resolution.
• Effectively assigns ICD-10-CM, modifiers, and HCPCS codes to outpatient records.
• Maintains 92% to 95% ICD-10-CM and/or HCPCS coding accuracy and consistently meets established productivity standards while keeping abstracting errors to a minimum.
• Mentors and trains newly hired Coders and provides ongoing training of Coding staff.
• Assists the Coding Manager with special coding assignments or coding tasks to resolve unbilled issues.
• Serves as a resource for all coding-related questions, responding in a timely manner to requests and questions from Coding staff.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Ensures safe care to patients, staff, and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity, and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of the community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.
• Other duties as assigned.