Coding Specialist - Outpatient Telecommute

SUMMARY

Reports to the Coding Manager. Reviews outpatient clinical documentation, extracts data, assigns ICD-10-CM and CPT codes per guidelines, uses 3M 360 Finder, resolves claim edits, coordinates with physicians, monitors uncoded reports, and maintains quality and productivity standards.

RESPONSIBILITIES

Enter coded extracted information into 3M 360 Finder, assigning accurate APC and reviewing all coding edits. Understand and follow all National Correct Code Initiative Edits (NCCI) and pertinent medical necessity requirements. Resolve accounts on the claims edit database. Assign injections and infusion codes for observation patients. Meet the minimum productivity standard, maintaining an average accuracy rating of 95%. Assign E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits ensuring medical record documentation supports the code. Ensure physician-entered diagnosis, ICD or CPT codes are accurate and supported by documentation. Utilize 3M to identify and resolve NCCI edits before final billing. Report documentation insufficiencies to the responsible physician. Follow Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients under 18 years of age. Monitor and resolve rejected accounts on the Claims Edit Report and e Clinical Works error reports within established timeframes, researching coding conflicts including chargemaster, medical necessity and other billing issues. Refer complex coding issues to the coding validator or supervisor. Review pertinent outpatient uncoded reports, researching and resolving old uncoded accounts and any accounts posted on report for which the charges are inappropriate. Update patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follow established procedures for rebilling accounts. Perform related clerical duties as required. Maintain level of knowledge and expertise pertinent to the position.

MINIMUM QUALIFICATIONS

High school diploma or equivalent and successful completion of a formal coding educational program. Ability to read and understand outpatient clinic medical record documentation for reporting of outpatient clinic, ancillary and endoscopies. Certification from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC). One to two years of experience in outpatient coding or billing. Ability to meet and maintain established quality and productivity standards.

WORKING CONDITIONS

Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, and use step-stools to file records. Ability to work under stressful conditions to maintain accounts receivable days while achieving productivity and accuracy.

INDEPENDENT ACTION

Performs independently within the department’s policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures is required.

SUPERVISORY RESPONSIBILITY

None.

PAY RANGE

$24.29-$40.07

EEO STATEMENT

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

LOCATION

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

WORK TYPE

Variable

WORK SHIFT

Variable

DAILY HOURS

8 hours

DRIVING REQUIRED

No #J-18808-Ljbffr Brown University Health