Outpatient Coder

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Job Details

Outpatient Coder

Job Overview

Outpatient Coder

Overview:

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Outpatient Coders needed
Day Surgery, OBS, ED

In accordance with both Coding Guidelines, the Medical Coding Specialist II determines the appropriate ICD-10-CM, CPT, CDT, and HCPCS, or HCC codes for providers and facility services based on clinical documentation. This position may include coding multiple (sub)specialties, professional component coding of inpatient facility, outpatient facility, non-facility and/or professional fee agreements and/or the facility/technical component. This position may also include some charge entry for outreach billing. The incumbent may also be responsible for provider and staff education.

MAJOR RESPONSIBILITIES

 

  • • Review information available in the electronic medical record and/or paper record to accurately code the episode of care in multiple specialty areas, including inpatient and outpatient settings.
  • • Utilize available encoder, grouper software, and other coding resources to determine the appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes.
  • • Maintain an understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines, applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.
  • • Actively participate in and maintain coding quality and productivity processes
  • • Communicate directly with physician and non-physician providers to resolve conflicting provider documentation to establish cause and effect relationships between conditions and further specify diagnoses and procedures documented within the medical record.
  • • Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. Assist with educational in-services for physicians, other providers, and clinic staff relating to documentation compliance as well as new policies and procedures related to billing.
  • • Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate.
  • • Navigate software workflows and processes to identify and resolve appropriate electronic rules and create efficiencies.
  • • Participate in training new coding staff, as needed.
  • • HCC Specific responsibilities: o Reviews documentation to identify ICD-10-CM diagnoses, that map to a Risk Adjusted HCC ensuring the documentation meets all CMS standard requirements for valid HCC Submission
  • o Participates effectively in Clinical Documentation initiatives and team meetings to promote quality across cross-functional departments.

 

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