Coder III Outpatient

Avera • Sioux Falls, SD

2d

About The Position

The Coder III Outpatient is responsible for timely and accurate assignment of diagnostic and procedural codes for most types of outpatient charts across multiple Avera Health facilities, with a focus on complex and high-dollar cases. The role also involves accurate abstracting, reporting, and editing. The Coder III works independently to meet quality and production goals and spends varied amounts of time educating coders and assisting with denials management.

The position reviews clinical documentation to assign appropriate ICD-10-CM, CPT, and HCPCS codes, and determines appropriate APC/EAPC or medical coding for a variety of outpatient services. The role is expected to master most outpatient types in the service line and code them as needed. The Coder III serves as a coding subject matter expert, queries physicians and clinical documentation staff, supports denials and appeals work, and coordinates communication among health information management, billing, and providers.

The role requires adherence to Avera’s coding ethics, mission, values, confidentiality standards, and CARE standards. Employees must be able to perform the specified work hours and essential job functions, including adequate visual acuity and effective communication. Reasonable accommodations may be made unless they cause undue hardship.

Requirements

• One of the following credentials required within 180 days: Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or Certified Coding Specialist–Physician-based (CCS-P), all through AHIMA.
• Ability to work the hours specified.
• Ability to perform essential job functions, including visual acuity adequate for the position and effective communication, hearing, understanding, and distinguishing speech and other sounds.
• Ability to maintain confidentiality and work effectively in a team environment.
• Commitment to Avera’s mission, vision, core values, and social principles, and to its CARE standards.

Nice To Haves

• Associate degree in Health Information Administration or Health Information Technology.
• Four to six years of coding experience.

Responsibilities

• Review clinical documentation and assign the appropriate sequence of ICD-10-CM, CPT, and HCPCS diagnosis and procedure codes for assigned outpatient charts across Avera facilities.
• Maintain in-depth knowledge of ICD-10-CM, CPT, and HCPCS codes, updating that knowledge through research and educational opportunities.
• Determine appropriate APC/EAPC and medical coding for varied outpatient types, including surgeries, observation, injections and infusions, and oncology.
• Master and code the majority of outpatient types in the outpatient service line as needed.
• Serve as a coding subject matter expert for other health professionals within Avera.
• Query physicians and clinical documentation staff to ensure full capture of the clinical record.
• Assist staff with denials management, including processing edits, providing subject matter expertise, and contributing coding references for medical necessity and other appeals.
• Lead communication among health information management, billing, and providers as needed.
• Maintain personal quality and production statistics according to service line standards.
• Educate other coders and help others with denials management.
• Adhere to Avera’s ethical coding standards, maintain confidentiality, and comply with applicable safety principles, laws, regulations, and standards.
• Coordinate workflow with team members and contribute to a productive and efficient team environment.

Benefits

• PTO available on day one for eligible hires.
• Up to 5% employer matching contribution for retirement.
• Career development through hands-on training and mentorship.
• A range of benefits for qualifying part-time and full-time employees, designed to support balanced, healthy lives and current and future needs.

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: No Education Listed