CODER OUTPATIENT PROFESSIONAL SURGERY ER

US:NV:Carson City Health Information Management

Full Time

Summary

As an intermediate level clinical coding specialist, assigns compliant, complete, and accurate APC’s, ICD diagnosis codes, CPT/HCPCS procedure codes, E/M facility and Professional level codes, and modifiers. Primary patient types to include, hospital outpatient services, Emergency Department, Urgent Care, Ambulatory Surgery, Observation, and other outpatient and Professional clinics or services. Works collaboratively with other members of the health information management team 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, and maximum reimbursement.

Qualifications

• Required
• • Active; Minimum of one of the following credentials:
  • AHIMA RHIA or AHIMA RHIT or AHIMA CCS or CCS-P or AAPC CASCC or AAPC CGSC or AAPC COC or AAPC CPC or AAPC CIRCC or AAPC CANPC or AAPC CCVTC or AAPC CCC.
• Preferred
• • Any additional AAPC Specialty credential above minimum requirement
  • Two years of previous coding experience or one year as a CTH clinical coder 1.
  • Active AHIMA membership
  • Active AAPC membership
  • Associate’s degree in health information technology from an accredited program.

Essential Functions

• Assign compliant, complete, and accurate APC’s, ICD CM diagnosis codes, CPT/HCPCS procedure codes, E/M facility and professional level codes, and modifiers to the hospital outpatient and professional services. Services to include ancillary services, urgent care, emergency department, outpatient surgery, and other outpatient patient types, Professional IP, surgeries and office visits or procedures or other specialties as needed.
• Work professional denials and claim edits. Identify trends in denials.
• 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.
• Validate and / or capture the charge for the designated procedures.
• Adhere to ICD instructional notations and coding conventions to locate, select, and sequence diagnosis codes appropriately. Adhere to AMA CPT Assistant and AHA Coding Clinic for HCPCS for appropriate CPT procedure coding. Adhere to CPT instructional guidelines and notations to locate, select, and correctly sequence procedure codes appropriately.
• Adhere to regulatory (CMS) and other third party payer requirements pertaining to clinical documentation, coding and billing.
• Abstract accurately from the medical record all defined data elements such as diagnoses, procedures, modifiers, attending physician, 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 code assignment.
• Investigate and resolve claim edits received such as medical necessity, Medicare Outpatient Code Edits (OCE), or Correct Coding Initiative (CCI) edits.
• Maintain consistent level of accuracy and productivity standards.
• Maintain continued education requirements of AHIMA or AAPC.
• Assist with special projects as needed and performs related duties as assigned.