Outpatient Hospital Reimbursement & Coding Specialist III, Remote

Job Summary

Utilizing an electronic medical record and computerized encoder, assigns and sequences diagnosis and procedure codes and present on admission indicators (inpatient only) on inpatient or outpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures.

Detailed Responsibilities

• Reviews inpatient or outpatient medical records to assign and sequence all appropriate diagnosis and procedures codes utilizing encoder software and following by proficiently translating diagnostic statements, procedure descriptions, physician orders, and other pertinent documentation.
• Reviews Medicare Severity Diagnosis Related Groups (MSDRGs) and All Patient Refined Diagnosis Related Groups (APRDRGs) on inpatient cases or Ambulatory Payment Classification (APCs) on outpatient cases for appropriate code assignment.
• Reviews and validates accuracy of Admission-Discharge-Transfer (ADT) data fields; abstracts admission type, point of origin, discharge disposition, physicians, procedure dates and on inpatient cases present on admission (POA) indicators.
• Reviews appropriate coding work queues daily to address coding edits and needed corrections and follows procedure to notify billing as needed.
• Reviews accounts and performs needed correction for internal audits and external denials.
• When documentation or valid order is incomplete, vague, or ambiguous, it is the responsibility of coder to work in conjunction with Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable diagnosis, procedure and/or physician order.
• Outpatient coders are responsible for following charge verification processes and routing accounts based on missing, incomplete, or inaccurate charging.

Other Responsibilities Include

• Adherence to Health Information Management (HIM) Coding policies.
• Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures.
• OP coding validates reason for visit and IP validates admit diagnosis.
• Adherence to Det Norske Veritas (DNV) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.
• Responsibility for maintaining coding certification and knowledge referencing diagnosis and procedural coding classification system coding guidelines and regulatory changes.
• Contact the appropriate department or physician for assistance in obtaining physician clarification of Diagnoses and procedures.
• Participates in performance improvement initiatives as assigned.

Position Requirement(s)

• Licenses/Certifications/Registrations Required: RHIT, RHIA, CCS, CPC, or CPC-H
• Licenses/Certifications/Registrations Preferred: N/A

Department Position Summary

The employee must be able to demonstrate the knowledge and skills necessary to optimally code inpatient or outpatient encounters (based on team assigned). The individual must demonstrate knowledge of the various payment schemes for inpatient encounters or outpatient encounters. The individual must demonstrate the ability to be flexible as to the type of encounter to be coded. The associate must demonstrate the ability to work in a self-directed team by taking and giving direction and sharing in the responsibility of the team. The associate must display the ability to be self-motivated, be able to evaluate the scope of each day's work, and display time management skills to accomplish assigned work. Must be able to work effectively in a remote work capacity. The associate must provide management with annual/biannual proof of certification and complete annual/biannual required continuing education. The associate will perform any other tasks as assigned.