Coder – Outpatient

Role Overview

• Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and/or CPT codes for billing, internal and external reporting, research, and regulatory compliance.
• Accurately codes conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting and/or CPT Assistant.
• Demonstrates knowledge of reimbursement methodologies and applies to assigned charts in order to optimize reimbursement and/or resolve regulatory edits.
• Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines and keeps abreast of coding changes and interpretation of codes.
• Reviews appropriate provider documentation to identify & assign diagnoses & surgical procedure or treatment codes using ICD-10-CM and CPT procedure codes as defined in facility specific guidelines.
• Meets established departmental productivity guidelines for the specific type of coding being performed with 95% accuracy on a consistent basis.
• Utilizes Care Connect, UDS and Clintegrity systems proficiently to obtain ICD-10-CM and CPT codes.
• Utilizes technical coding principals and APC/E-APG reimbursement expertise to assign appropriate ICD-10-CM diagnoses and CPT procedure codes.
• Formulates compliant coding queries when documentation is inadequate, ambiguous or unclear for coding purposes.
• Enters and/or updates data accurately in various systems as departmental policy indicates.
• Completes other duties as assigned by HIM leadership.
• Provide assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.
• Assigns appropriate discharge disposition and/or modifiers based on established coding guidelines.
• Analyzes clinical documentation to determine charge capture requirements for numerous clinical services.
• Uses reports and application queues to identify targeted accounts on a daily basis. Works with CDM team to ensure appropriate charges are in place and that associated CPT codes are current.
• Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.
• Attends RGHS, HIM Department and Coding Team meetings and training sessions as required. Ensure timely reporting for external regulations.

Requirements

• Advance coding certification credential: Certified Coding Specialist (CCS), Certified Coding Specialist
• Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC-H), Certified Medical Coder (CMC), RHIT/RHIA certification, Radiology Certified Coder (RCC), Certified Coding Associate (CCA), Certified Outpatient Coding (COC), Certified Inpatient Coder (CIC), Certified Risk Adjustment Coder (CRC), Certified Professional Coder-Payer (CPC-P), or any of the specialty coding certifications offered by AAPC (CASCC, CANPC, CCC, CCVTC, CCPC, CPCD, CEDC, CEMC, CFPC, CGIC, CGSC, CHONC, CIMC, CIRCC, COBGC, COPC, COSC, CENTC, CPEDC, CPRC, CRHC, CSFAC, CUC).
• Will consider RHIT eligible candidate who sits for the exam within one year of hire Full CPC certification must be obtained within 24 months if employee holds CPC-A from the American Academy of Professional Coders (AAPC) at time of hire or 36 months after certification if obtained after employment.
• For HOMECARE: Homecare Diagnosis Coding Specialist (HCS-D) certification required within 16 months of hire.
• Grandfather Clause: If hired on or before September 30, 2018, 2 years of relevant work experience and one of the following coding certification credentials: Certified Coding Specialist (CCS), Certified Coding Specialist
• Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder
• Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or a specialty coding certification and Associate’s degree in Health Information Management are required.

Benefits

• Rochester Regional Health is an Equal Opportunity / Affirmative Action Employer. Minority/Female/Disability/Veteran.