Outpatient Coder II

About the Role

Interprets a wide variety of clinical and diagnostic documentation in order to process hospital and/or pro-fee charges for episodes of outpatient care. Assigns appropriate ICD-CM (current edition) and CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as appropriate adhering to official coding guidelines. Primary focus is coding Emergency Medicine encounters for the technical and professional side.

Responsibilities

• Upon review of the medical record, performs analysis on documentation, which includes review of tests/reports to determine the appropriate ICD-CM (current edition) and/or CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as defined by official coding guidelines and other recognized reference materials.
• Verifies documentation is present to substantiate codes assigned.
• Assists in resolving incomplete and/or missing chart documentation in order to expedite coding and billing.
• Participates in the continuous coding audit and performance management program.
• Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
• Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
• Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
• Communicates to Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
• Refers all unusual, questionable situations to the direct Manager.
• Alerts management to any coding irregularities, or trends contrary to policies/procedures, so corrective measures may be taken.
• Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
• Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
• Keeps current with all coding updates and information related to correct coding.
• Complies with established departmental policies, procedures and objectives.
• Attends variety of meetings, conferences, seminars as required or directed.
• Demonstrates use of Quality Improvement in daily operations.
• Complies with all health and safety regulations and requirements.
• Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• Maintains regular, reliable, and predictable attendance.
• Performs other similar and related duties as required or directed.

Qualifications

License/Certification/Education:

• Required: High School diploma or equivalent
• Preferred: Medical coding certification. Training in medical terminology from an accredited program, completing and passing certification program within one year from date of hire. (Recognized programs include: American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC). Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P).

Experience/Skills

Required:

• Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits
• Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices
• Good interpersonal and communications skills and demonstrates professionalism
• Good customer service skills with the ability to communicate efficiently
• Good organizational skills with attention to detail
• Ability to work independently within established guidelines
• Ability to organize and coordinate multiple functions and tasks
• Ability to problem solve, organize and prioritize workload to meet productivity benchmarks
• Ability to withstand significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy

Preferred:

• Three (3) years of medical abstraction and outpatient coding experience or related work experience
• Evaluation and Management coding experience preferred

Schedule

• Monday through Friday
• Hours: 7:00 AM – 3:30 PM
• Shift: 1 - Day Shift, 8 Hours
• 40 hours per week