Outpatient Coder 2 Certified / HIM Coding

Position Summary

Reviews and validates outpatient and professional clinical documentation and diagnostic results. Extracts data and assigns alpha numeric codes for billing, internal and external statistical reporting, research, regulatory compliance and reimbursement. Codes complex diagnostic and procedural accounts, which includes but is not limited to the following: Professional Specialty Services Emergency Services Observation Same day surgery Pain Clinic Infusion Services Electrophysiology Cardiac Catheterizations LifeStar Orthopedic Critical Care.

Position Responsibilities

• Applies strong knowledge of anatomy and physiology, clinical disease processes, pharmacology, and diagnostic and procedural terminology to determine the appropriate assignment of diagnosis and procedure codes.
• Analyzes medical records, interprets documentation and assigns proper International Classification of Diseases, Tenth Edition Clinical Modification (ICD-10-CM), Current Procedural Terminology/Healthcare Common Procedure Coding System (CPT/HCPCS), modifiers, and Evaluation & Management codes utilizing designated software to include Computer Assisted Coding (CAC) and/or encoder, coding manuals and other reference material as required.
• Enters charges for procedures that are not soft coded as instructed for certain patient types.
• Adheres to all department coding/charging procedures, policies, guidelines and quality standards.
• Completes on a daily basis cases that have been assigned to them utilizing the appropriate work lists.
• Codes complex diagnostic and procedural accounts, which includes but is not limited to the following: Professional Specialty Services Emergency Services Observation Same day surgery Pain Clinic Infusion Services Electrophysiology Cardiac Catheterizations LifeStar Orthopedic Critical Care.
• Affords assistance to manager with special projects/other tasks as assigned.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines.
• Maintains revenue cycle goals (Key Performance Indicators (KPIs) and Productivity Standards).

Issue Resolution

• Reviews claim edits and revises coding/charging as appropriate for specific range of ICD-10-CM/CPT/HCPCS codes.
• Reviews accounts returned from various departments (including Customer Service, Billing, Coding Quality, and Revenue Integrity) and processes corrections for clean claim submission or posts claim denial review for appeal.

Communication

• Seeks clarification from physicians or other staff in cases where documentation is absent, ambiguous, or contradictory.
• Makes corrections based on collaboration with clinician or designee.

Training

• As assigned, assists in training new coders to become acclimated to the environment and in understanding internal coding policies and procedures, and documentation guidelines.

Qualifications

• Education: Associate’s Degree or equivalent experience.
• Experience: Minimum: Two years of progressive on-the-job experience in an acute care hospital or physician’s office. Preferred: Two to four years of progressive on-the-job experience in an acute care hospital or physician’s office.
• Licensure, Certification, Registration: CPC, COC, or CCS certification required and maintained thereafter.
• Language Skills: Strong written and verbal communication skills.
• Knowledge, Skills And Ability Requirements: Strong knowledge of: ICD-10-CM diagnostic and CPT/HCPCS procedure codes Clinical information related to areas of responsibility Microsoft Office Products; Word, Excel Encoder and/or Computer Assisted Coding product (CAC) Skills Read, write and speak English proficiently. Strong analytical capabilities. Strong organizational skills. Proficiently read and interpret physician documentation. Strong Ability To Function independently. Handle multiple priorities. Listen and acknowledge ideas and expressions of others attentively. Converse clearly using appropriate verbal and body language. Collaborate with others to achieve a common goal through mutual cooperation. Influence others for positive and productive outcomes. Use independent judgment to solve problems. Work across the Hartford HealthCare System.