Outpatient Certified Coder

About the Role

The role of a Certified Outpatient Coder at Care New England is to ensure accurate assignment of ICD-10 CM, CPT, and HCPCS codes on a wide range of patient medical records for outpatient services. Outpatient services include, but are not limited to observation, surgical, provider-based visits, interventional radiology, emergency room, oncology, and other specialty services. The role requires a proficient understanding and execution of coding guidelines to ensure accuracy and maintain records in accordance with accepted medical and legal standards, as well as adherence and compliance to various regulatory guidelines from CMS, AHA, and AMA.

Responsibilities

• Analyze medical records, extracting clinical, pathological, therapeutic, and epidemiologic data in accordance with established ICD-10-CM coding principles and guidelines.
• Assign codes and code all diagnostic and operative information from the medical record using ICD-10-CM, ICD-10-PCS, CPT, and HCPCS coding classification systems; independently quality-check own work.
• Assign ICD-10 diagnosis codes, validate CPT codes, and assign modifiers.
• Ensure that all data abstracted is consistent with guidelines outlined by JCAHO, CMS, regional, and local policy.
• Evaluate, address, and understand CCI, LCD, and NCD edits.
• Ensure data is optimally coded for documentation capture, financial reimbursement, care planning, statistics, and regulatory reporting.
• Review medical records to determine accurate required abstracting elements (facility/client-specific elements), including appropriate discharge disposition to ensure accurate reimbursement.
• Demonstrate a comprehensive, expert-level knowledge of all procedures concerning the sequencing of diagnoses and procedures, such as those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines, and other appropriate classification systems.
• Demonstrate knowledge of anatomy, physiology, pharmacology, and pathophysiology to interpret general medical classifications for coding discharge data.
• Ensure timely record availability by meeting established coding and abstracting productivity and accuracy standards.
• Communicate and resolve coding issues around documentation for appropriate follow-up and education.
• Interact and communicate with department lead and manager to clarify and accurately document patient diagnostic and procedural information.
• Maintain and comply with policies and procedures for confidentiality of all patient records.
• Perform other related duties as assigned.

Requirements

• High School diploma or GED required; Associate's Degree preferred.
• At least three (3) years of hospital experience within the last five years.
• Preferred certification as a Certified Coding Specialist (CCS). A Certified Professional Coder (CPC) certification will also be considered with additional years of experience.
• Completion of classes in medical terminology, anatomy and physiology, ICD-10 and CPT coding conventions, and disease process from an accredited program.
• Coding certification must be maintained.
• Ability to demonstrate knowledge of and utilize auditing skills related to coding quality and compliance.
• Ability to understand the clinical content of a health record, including the most complicated records.
• Ability to communicate with others to clarify diagnoses/procedures and sequencing of diagnoses.
• Strong attention to detail and accuracy; must abide by the AHIMA coding code of ethics.
• Ability to maintain department productivity and accuracy standards.

About Us

Care New England Health System (CNE) and its member institutions—Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group—is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in important discussions about health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.