Outpatient Surgery Coder

About the role

Nemours Children's Health is seeking an Outpatient Surgical and Observation Coder. This role involves assessing documentation for each service rendered in the hospital’s place of service to accurately code principal diagnoses, secondary conditions, procedures, and social determinant codes.

Responsibilities

• Comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Maintain production and quality metrics monthly.
• Apply a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Understand and apply M.E.A.T. criteria (monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyze high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (e.g., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Incorporate payer specific trends into day-to-day reviews to reduce "take backs" associated with unclear or un-substantiated care rendered (e.g., varying modifier assignment for EAPG vs. Non-EAPG payer specificity).
• Maintain excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (e.g., CCS, CPC, RHIT, RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrate an excellent working knowledge of hospital information systems to retrieve data specific information (e.g., order diagnosis, patient type) within a complicated filing schema including non-hospital data (e.g., Media Tab, Office Visits etc).

Qualifications

• Minimum education of an Associate's degree required.
• Medical Terminology, Anatomy and Physiology required.
• One of the following certifications required: CPC, CCS, RHIT, RHIA, COC (please include on resume).