Coder II

OhioHealth•WORK AT HOME - OHIO, OH

About The Position

This position performs facility coding and abstracting for outpatient cases, including Emergency Department, Diagnostics, MSF and Recurring Patient types, Ambulatory Surgery, Observation, Outpatient in a Bed, and/or Clinic accounts. The Coder assigns diagnoses and procedures using medical-record documentation and applicable coding guidelines, supports accurate charging, and completes data abstraction and account follow-up while meeting a 95% quality standard and minimum productivity requirements. The role includes coding complex general surgery cases and applying relevant ICD-9, ICD-10, CPT-4, modifier, and medical-necessity guidelines. The Coder identifies documentation that requires clarification, retrieves supporting documentation from source systems, and assists with reviews of accounts denied by RAC and other governmental payers. Other duties include assigning transaction codes when documentation is insufficient, abstracting data for UB-04 and reporting requirements, verifying account details, and identifying problem cases for follow-up.

Requirements

High school diploma or GED.
Completion of a two-year program and coding certification from AHIMA or AAPC, and/or graduation from a HIM program with RHIA or RHIT certification.
Demonstrated knowledge of ICD-9, ICD-10, and CPT-4 classification systems.
Knowledge of advanced anatomy and physiology, medical terminology, ambulatory reimbursement schemes, and CMS LCD and/or NCD guidelines.
Advanced knowledge and expertise in general surgery coding, including complex surgical procedures, interpretation of operative reports, surgical anatomy, CPT coding guidelines, modifier application, and NCCI edits.
Strong analytical and critical-thinking skills and the ability to independently review, interpret, and accurately code complex general surgery cases, resolve coding discrepancies, and apply coding guidelines while maintaining compliance and accuracy standards.
AAPC or AHIMA credential or certification, including RHIA or RHIT as applicable.

Responsibilities

Assign admit, reason-for-visit, principal and secondary ICD-9, ICD-10, and CPT-4 diagnoses and procedures based on medical-record documentation and applicable coding guidelines.
Maintain a 95% quality level and meet and maintain minimum Coder productivity requirements.
Apply appropriate CPT modifiers for facility coding when necessary.
Review records for diagnoses that support medical necessity for diagnostic and surgical procedures under applicable CMS Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) guidelines.
Recognize when physician clarification is needed because documentation is inadequate, ambiguous, or unclear, and follow department policy for physician queries.
Accurately code and charge clinic accounts, including assigning a facility E/M level using the Ohio Health Scorecard for guidance.
Retrieve documentation from non-HIM department source systems, including GE Gentricity and Mosaic, to support account coding.
Assist educators and supervisors in reviewing accounts denied by RAC and other governmental payers for documentation supporting the original coding.
When documentation is insufficient, missing, or conflicting, assign transaction codes in the HBOC system and follow department policy for follow-up and physician queries.
Abstract data elements needed to complete UB-04 and meet hospital-reporting requirements.
Verify demographics, correct account numbers, charges, and services, and identify missing or incorrect forms in each record.
Identify problem cases on the DNFB and forward them to appropriate staff for follow-up.
Perform other duties as requested by the supervisor.