Coder Outpatient Professional

US:NV:Carson City Health Information Management

Full Time

Summary

The Clinical Coding Specialist Level I assigns compliant, complete, and accurate ICD diagnosis codes for the hospital component of outpatient ancillary services, based upon the clinical documentation provided within the medical record. Works collaboratively with other members of the health information management department to complete all essential responsibilities in a timely fashion to meet the quality, utilization, and financial needs of the organization. Ensures complete and accurate abstraction of the medical record data.

Qualifications

Required

• Active AHIMA CCA or CCS-P or CCS or AAPC CPC or CPC-A or AAPC COC or COC-A or AAPC CEMC or AAPC COSC or CGSC

Preferred

• High school graduate or equivalent.
• AHIMA RHIT or RHIA
• Associate’s degree in Health Information Technology from an accredited program.
• Hospital Billing experience
• One Year coding experience or one year as a HIM coder/biller.
• Two years of previous hospital or medical office experience.

Essential Functions

• Assign compliant, complete, and accurate ICD diagnosis codes, E/M facility and professional level codes, and modifiers to the hospital and professional outpatient services.
• Identify anatomy and physiology, clinical disease processes, pharmacology, and diagnostic terminology to assign accurate diagnosis codes. Search appropriate reference materials to obtain current information, guidance, and requirements as needed.
• Knowledge and adherence to UHDDS definitions, ICD Official Guidelines for Coding and Reporting, and Coding Clinics for ICD for appropriate diagnosis coding.
• Adhere to ICD instructional notations and coding conventions to locate, select, and sequence diagnosis codes appropriately.
• Adhere to regulatory (CMS) and other third party payor requirements pertaining to clinical documentation, coding and billing.
• Abstract accurately from the medical record all defined data elements such as diagnoses, attending physician, consultants, surgeons, discharge disposition, hospital service, etc.
• Retrieve any missing documentation needed to ensure compliant coding and optimal reimbursement. Clarify with the appropriate provider and HIM analysts all incomplete, ambiguous, and / or conflicting clinical documentation when further specificity is needed for accurate and complete diagnosis(es) code assignment.
• Investigate and resolve claim edits received such as medical necessity or Medicare Outpatient Code Edits (OCE).
• Maintain consistent level of accuracy and productivity standards as dictated in policy or guidelines from AHIMA.
• Assist with any charging, or revenue integrity processes as needed.
• Maintain continued education requirements of AHIMA or AAPC.
• Assist with special projects as needed and performs related duties as assigned.