Coder II

Coder II

Under general supervision of the Director, the Coder II provides consistency and efficiency in outpatient claims processing and data collection to optimize APC reimbursement and facilitate data quality in outpatient services. Reviews, audits, and reports on charge capture. Maintains patient confidentiality at all times.

Every effort has been made to make this job description as complete as possible. However, it in no way states or implies that these are the only duties the incumbent will be required to perform. The omission of specific statements of duties does not exclude them from the position if the work is similar, related or is a logical assignment to the position.

1. Analyzes IP, OP, Recurring, & SDC records and appropriately codes per coding guidelines, ICD-10-CM and CPT rules and updates, creating APC or DRG group assignments.
2. Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
3. Concurrently codes Recurring records for interim billing.
4. Processes records for deficiencies and return for completion.
5. Enters codes into the Abstracting Module as needed, including use of the 3M encoder.
6. Performs data quality reviews on outpatient encounters to validate the ICD-10-CM, CPT, and HCPCS Level II code and modifier assignments, APC group appropriateness, missed secondary diagnoses and/or procedures, and ensure compliance with all APC mandates and outpatient reporting requirements. Monitors medical visit code selection by departments against facility specific criteria for appropriateness. Assists in the development of such criteria as needed.
7. Evaluates the quality of clinical documentation to spot incomplete or inconsistent documentation for outpatient encounters that impact the code selection and resulting APC groups and payment. Brings identified concerns to medical staff, nursing, or department managers for resolution.
8. Provides training of facility healthcare professionals use of coding guidelines and practices, proper documentation techniques as needed for outpatient reimbursement.
9. Investigates, monitors and develops reports for studies involving outpatient encounter data for clinical evaluation purposes and/or financial impact.
10. Demonstrates competence in the use of computer applications and APC Grouper Software, OCE edits, and all coding and abstracting software and hardware currently in use.
11. Performs periodic claim form reviews to check code transfer accuracy from the abstracting system and the chargemaster.
12. Monitors outpatient unbilled accounts report for outstanding and/or uncoded outpatient encounters to reduce accounts receivable days for outpatients.
13. Keeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements, and other future issues impacting the coding function.
14. Maintains established department policies, procedures, objectives, quality assurance, safety environmental and infection control.
15. Enhances professional growth and development through in-service meetings, education programs, conferences, workshops, etc.
16. Abides by the HMH Legal Compliance Code of Conduct.
17. Maintains a safe work environment and reports safety concerns appropriately.
18. Maintains patient confidentiality and appropriate handling of PHI.
19. Performs all other related duties as required and assigned.