Hospital Based Outpatient Coder I - HIM - FT - Days - Remote Eligible

Reviews medical record documentation. May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance.

Responsibilities

Reviews medical record documentation; May assign codes to medical diagnoses, procedures and modifiers, when applicable, using appropriate coding classifications for assigned areas/record types to ensure proper billing and compliance; Enhances and maintains coding knowledge and skills; Reviews all appropriate work queues daily to address edits and makes corrections following procedures and processes; Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding; For physician billing, collaborates with billing department to ensure all bills are satisfied; For hospital, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing; Makes appropriate coding corrections, when advised, and follows procedure to notify billing; Reviews and validates the accuracy of data in the Admission, Discharge Transfer (ADT) fields following HIM coding procedures and processes; May assign and sequence basic CPT procedure codes (non-complex), and modifiers based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP) guidance in encoder software and/or department coding policies and procedures; Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments; Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity; Researches medical record for any additional diagnoses documented to meet medical necessity; Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate (physician billing); Communicates with insurance companies about coding errors and disputes (physician billing); Abstracts pertinent data points for billing and quality reviews; Communicates with various departments as needed to ensure accuracy of patient data; Submits daily productivity report to HIM manager by defined deadline; Meets and maintains HIM coding quality and productivity standards; Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements; Reviews medical record documentation to determine all appropriate diagnosis (including HCC Coding Hierarchical Condition Category), procedural and modifier code assignments; For hospital coding, reviews medical record documentation (i.e., provider orders); may code outpatient diagnostic and therapeutic encounters requiring minimal procedural coding

Requirements

High School Diploma or Equivalent; Required certification (one of): Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA), Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA), Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Registered Health Information Technician (RHIT) - State of Florida (FL), Registered Health Information Technician (RHIT AHIMA) - American Health Information Management Association (AHIMA); Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision; Must be able to work in a stressful environment and take appropriate action; Proficient in basic computer skills; Ability to perform job duties using an electronic medical record system; Strong knowledge of anatomy, physiology and medical terminology; Knowledge of coding classification systems and procedures; For HIM coder, one (1) year hospital-based outpatient coding experience; For Physician Billing Coder, one (1) year diagnostic/procedural office coding experience with surgical coding experience or six (6) months working within the Memorial Health System; For HIM: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA); For Physician Billing: Certified Professional Coder (CPC), Certified Professional Medical Auditor (CPMA), Certified Risk Adjustment Coder (CRC) by AAPC, or Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCSP) by AHIMA; For Hospital Billing: Certified Coding Specialist (CCS), Certified Coding Associate (CCA), or Certified Professional Coder (CPC)