Coder - Outpatient

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JOB SUMMARY:
The position is responsible for the ICD-10-CM, ICD-10-PCS (when applicable), CPT-4, and modifier assignment of diagnosis and procedures of an Outpatient visit. The position is required to stay current on all aspects of Medicare/Medicaid requirements, sequencing, Coding Guidelines, coding clinics, CPT Coding and CPT Assistant. Performs quality improvement reviews as assigned, or as required by Accreditation Agencies. Assign modifiers to CPTs as appropriate. Assign Physician Quality Reporting (PQRS) codes as appropriate. Review and/or assign patient severity of index illness ratings, supplemental codes, and other data as necessary. Maintain knowledge of new and revised codes as well as industry regulations to complete accurate coding services, including local coverage determinations. Update reports as needed for tracking of workflow and trending as necessary. Identify and track dictation opportunities. Review clinical documentation and diagnostic results as appropriate to extract date and apply appropriate ICD-10-CM/PCS and CPT-4 codes for billing, internal and external reporting, research, and regulatory compliance. Accurately code outpatient conditions and procedures as documented in accordance with the ICD-10-CM/PCS Official Guidelines for Coding and Reporting and the Standards of Ethical Coding.
JOB SPECIFIC RESPONSIBILITIES:
• Assigns codes for diagnoses, treatments, and procedures according to the appropriate
classification system for outpatient encounters.
• Utilizes technical coding principles and APC reimbursement expertise to assign appropriate ICD-
10-CM/PCS diagnoses and ICD-10-CM/PCS and CPT-4 procedures.
• Enters required information into 3M encoder and IDX extracted from source documentation
consistently and in additional elements as specified by Coding Manager (ex. Coding ICD-10-PCS
for Blue Cross financial class and for all other financial classes enter "Operating Phy")
• Assists in implementing solutions to reduce back-end billing errors
• Resolve error reports associated with billing processes, identify error patterns, and when
necessary assist in changes to reduce billing errors.
• Sequencing of codes will be accomplished as allowed by coding guidelines to ensure proper
billing and reimbursement.
• Maintain productivity levels for Outpatient Coder per day.
• Shall complete all four quarters of the AHA Coding Clinics.
• Shall demonstrate technical ability/knowledge of coding rules and regulations for coding.
• Maintain knowledge of new and revised codes as well as industry regulation to complete
accurate coding services.
EDUCATION AND EXPERIENCE:
Completion of a Health Information Technology program or Coding Certificate/Credential is required for the position. A coding certificate/ credential is required for the coder. RHIA, RHIT, CCS, CCS-P, CPC, other coding credential will be reviewed. Two years' experience in Health Information Management Coding or on the job training while enrolled in Coding Certificate Program.
REQUIRED LICENSURES/CERTIFICATIONS/REGISTRATIONS:
The position requires a Registered Health Information Technician, based on successful completion of examination requirements of the American Health Information Management Association, Certified Coding Specialist, or Coding Certificate.
SKILLS AND ABILITIES:
Technical Competence-every employee is expected to display an acceptable level of technical Competence in carrying out their assigned duties. The specific duties and job Standards for this position are listed below. Employee is expected to: Demonstrate a thorough understanding of the ICD-10-CM Classification System, Current Procedural Terminology, AHA Coding Clinics for ICD-9-CM, and AMA CPT Assistant. Demonstrate a thorough understanding of sequencing of diagnoses. Demonstrate a thorough understanding of CPT coding. Demonstrate a thorough understanding of Medical Terminology, Anatomy and Physiology, Coding Clinics, CPT Assistants, and Coding Guidelines.
INTERACTION WITH OTHER DEPARTMENTS AND OTHER RELATIONSHIPS:
This position requires interaction with medical staff and ancillary areas in order to facilitate a quality multidisciplinary approach to patient care.
PHYSICAL CAPABILITIES:
Work is mostly sedentary, but walking and standing are frequent. Must be able to appropriately deal with problems, interruptions, and other like situations. Must be able to work without direct supervision.
ENVIRONMENTAL/WORKING CONDITIONS:
Inside environmental conditions: maintained consistent to the fullest extent possible. Work from home with flexible hours. Maybe be asked to work in-house, at Supervisor's discretion. Maybe asked to work a set schedule, at Supervisor's discretion, position is responsible for personal internet maintenance and reliability. UMC is only Responsible for maintenance of UMC owned equipment that is used at home performing work duties, not personally owned equipment.
UMC Health System provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment on the basis of race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.
*Request for accommodations in the hire process should be directed to UMC Human Resources.*