Completes clinic and outpatient coding audits to ensure accurate code assignment by coding staff. Responsible for coding edits to ensure accounts reflect appropriate CPT codes, modifiers, and units of service to facilitate correct outpatient billing as defined by Medicare and Commercial Payers. Assists in the identification and trending of errors which could result in a denial.
Associate's or Bachelor's degree or equivalent in Health Information Management required.
Minimum of 5 years in coding of hospital outpatient and/or professional services.
Certified Professional Coder (CPC) required.
Certified Professional Medical Auditor (CPMA) required or obtained within 1 year of employment.
Knowledge of International Classification of Disease (ICD)-10 Clinical Modification (CM) and Current Procedural Terminology (CPT) coding required.
Knowledge of provider based coding/billing methodology is preferred.
Thorough knowledge of International Classification of Disease (ICD)-10.
Knowledge of Anatomy and Physiology, Disease Process, and Medical terminology as it relates to coding.
Attention to detail and completeness.
Capability to apply judgment and make informed decisions with little guidance.
Ability to communicate effectively and professionally, both orally and in writing.
Facilitate effective working relationships and build consensus.
Ability to plan, organize, prioritize, and work independently.
Ability to solve problems and identify solutions.
Ability to work effectively both as a team player and as a leader.
Knowledge of computer systems and software used in functional area.
Must be able to handle frequent interruptions throughout the day.
Must have strong understanding in both APC methodologies to ensure maximum reimbursement.
Sedentary Work - Exerting up to 10 pounds of force. Sitting most of the time. Walking and Standing are required only occasionally.
Not neccessary for the position (0%):
Occasionally Performed (1%-33%):
Frequently Performed (34%-66%):
Constantly Performed (67%-100%):
Chemical agents (Toxic, Corrosive, Flammable, Latex)
Biological agents (primary air born and blood born viruses) (Jobs with Patient contact) (BBF)
Radiation Alpha, Beta and Gamma (particles such as X-ray, Cat Scan, Gamma Knife, etc)
Radiation Non-Ionizing (Ultraviolet, visible light, infrared and microwaves that causes injuries to tissue or thermal or photochemical means)
Mechanical moving parts/vibrations
Essential Job Functions
Essential Functions I
Audit clinic & outpatient claims for all coders as directed by management.
Develop and maintain audit spreadsheet for each outpatient coder per the direction of management.
Collaborates with Outpatient Coding Education Coordinator and Trainer and Supervisor of Outpatient Coding for identification and development of training materials for outpatient coders.
Resolves Edits to ensure all accounts reflect appropriate Current Procedure Terminology (CPT) codes, modifiers, and units of services to facilitate correct billing as defined by Medicare.
Assist with reviews/updating of charge master to ensure appropriate charging for outpatient services by working with Business Office in reviewing charge master with departments providing outpatient services.
Works with departments on charge master inconsistencies.
Work with Coding Educator/and Coding Management to ensure adequate documentation on clinic & outpatient records to support billing for services provided by developing and implementing documentation standards.
Identifies areas of documentation inconsistencies.
Works with Business Office on denials by reviewing submitted charges and coding; resolve issues to enhance account payment timeless.
Works denials report sent by the Business Office.
Serves as an outpatient coder when volumes exceed department standards as determined by management.
Essential Functions II
Participates in mandatory in-services and/or CE programs as mandated by policies and procedures/external agencies and as directed by management.
Follows and understands the mission, vision, core values, Employee Standards of Behavior and company policies/procedures.