Outpatient Coder

Job Title

The Outpatient Coder I provides timely, complete, and accurate code assignment and data collection for quality clinical analysis and revenue enhancement.

Primary Responsibilities

Validates accuracy of codes assigned by the computer assisted coding tool, recognizing inappropriate application of clinical coding rules/guidelines and making revisions to the codes, while interpreting clinical documentation to ensure codes reported are clearly and consistently supported by the health record.

Upholds regulatory compliance by consulting validated coding references for accurate code assignment and sequencing rules, i.e., ICD-9 /ICD-10 and CPT-4 Official Coding Guidelines, AMA Coding Clinics for ICD-9/10, AMA Coding Clinic for HCPCS, AMA CPT Assistant, National Correct Coding Initiative edits, National and Local Coverage Determinations, medical dictionary, pharmaceutical and drug references, and anatomy and physiology references, etc.

Requests clarification from provider when there is conflicting, incomplete, or ambiguous information in the health record regarding a significant reportable condition or procedure or other reportable data element.

Verifies coding accuracy as per departmental standards; approving, editing, and assigning ICD9/ICD 10 and CPT-4 codes in the computer assisted coding application based on physician documentation in accordance to coding and compliance guidelines.

Abstracts pertinent information accurately and completely into the computer assisted coding application, notifying medical records and registration personnel of identified discrepancies of patient information in the medical record.

Maintains and observe patient confidentiality as outlined in the National Patient Safety Goals and HIPAA guidelines protecting the confidentiality of the health record at all times and refuse to access protected health information not required for coding-related activities.

Attends monthly department meetings and bi-monthly coding roundtables and all departmental educational opportunities offered related to the appropriate field of coding expertise.

Reviews industry updates like Coding Clinic or ICD-10 quarterly updates or CPT Assistant for maintain working industry standard knowledge.

Provides professional, precise, and complete communication with physician office, registration staff, other associates, and leadership regarding documentation concerns related to medical necessity issues identified as necessary to clarify documentation or coding related issues.

Analyzes and replies to denial management issues presented identifying documentation concerns and validating accuracy and completeness in code assignment.

Responds timely to pre-bill edits received ensuring a prompt turn-around-time to assist in facilitating an efficient revenue cycle.

Ensures that all work areas and equipment, whether remote or on-site, are in safe and working condition.

Work Experience

Minimum Qualifications:

• Education: High School Diploma or equivalent.
• Work Experience: One (1) year of experience in healthcare.
• Licensure: None
• Certification: None

Skills/Knowledge/Abilities:

• Ability to pass outpatient coding assessment with a score of 75% or more.
• Strong written and oral communication skills for professional interaction.
• Excellent computer and telephone skills.
• Ability to read and comprehend instructions, correspondence, memos, and electronic mail.
• Must be detail and accuracy oriented.
• Ability to coordinate and use logical reasoning to facilitate daily workflow assignments.
• Ability to multi-task.
• Ability to work independently maintaining focus on scope of work assigned.
• Knowledge of the regulatory environment and legislation related to code assignment changes, local coverage determinations, and national coverage determinations.
• Literacy and proficiency in computer technology and Health Information/Coding applications needed for departmental efficiency and job performance.
• 4Solid proficiency in computer assisted coding work flow processes with accurate execution and efficiency.
• Knowledge of structure and content of the electronic health record displaying ability and competency to navigate the EHR accurately and efficiently for data quality collection and code assignment.
• Ability to earn five (5) CEUs yearly related to coding profession.
• Excellent communication, problem solving and critical thinking skills.
• Demonstrate behavior that reflects integrity, shows a commitment to ethical and legal coding practices, and fosters trust in professional activities.
• Ability to provide departmental coding coverage by cooperating with occasional schedule revisions and overtime requests when staffing needs arise.
• Ability to be accountable and dependable on time and attendance records to ensure daily workflow and departmental productivity guidelines are met.

Preferred Qualifications:

• Work Experience: One (1) year of coding experience or revenue cycle experience.
• Certification: Coding certification (e.g., AHIMA, AAPC).

Physical Requirements

Majority of time involves sitting or standing; occasional walking, bending, and stooping. Long periods of computer time or at workstation. Light work that may include lifting or moving objects up to 20 pounds with or without assistance. May be exposed to inside environments with varied temperatures, air quality, lighting and/or low to moderate noise. Communicating with others to exchange information. Visual acuity and hand-eye coordination to perform tasks. Workspace may vary from open to confined. May require travel to various facilities within and beyond county perimeter; may require use of personal vehicle.

About Health First

At Health First, diversity and inclusion are essential for our continued growth and evolution. Working together, we strive to build and nurture a culture that recognizes, encourages, and respects the diverse voices of our associates. We know through experience that different ideas, perspectives, and backgrounds create a stronger and more collaborative work environment that delivers better results. As an organization, it fuels our innovation and connects us closer to our associates, customers, and the communities we serve.

Schedule

Full-Time

Shift Times

8:00am to 4:30pm

Paygrade

PG-PG-30