Outpatient Certified Coder - Health Information Management

Ventura County•Ventura, CA

5d•Onsite

About The Position

The Health Care Agency is seeking a Coder-Certified to perform outpatient facility and physician professional fee (Pro-Fee) coding across hospital and ambulatory care settings. Under general direction, the Coder-Certified reviews and analyzes medical documentation, assigns appropriate diagnosis and procedure codes, applies coding and billing guidelines, and collaborates with physicians and other healthcare professionals to support accurate and compliant coding. The ideal candidate has specialized knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, E/M coding, outpatient surgery coding and applicable reimbursement methodologies including PPS, DRG, and APC along with strong analytical, organizational, and communication skills. This position offers an opportunity to work across a variety of outpatient services and specialties while contributing to accurate documentation, appropriate reimbursement, and quality patient care. This classification is unique in that it requires specialized knowledge and certificates relating to medical coding of records. Training/assignment assessments may be conducted to determine candidates' current skills and identify growth opportunities.

Requirements

Two (2) years of recent experience in an acute care setting using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS and/or DRG assignments.
Must have experience performing outpatient hospital and physician professional (Pro-Fee) coding.
For Hospital Coding - Must possess one or more of the following certifications, certified by the American Health Information Management Association (AHIMA): Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Associate (CCA).
Certified Professional Coder (CPC) as credentialed by the American Academy of Professional Coders (AAPC).
For Physician Professional Coding - Must possess one or more of the following certifications, certified by the American Health Information Management Association (AHIMA): Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P).
Certified Professional Coder (CPC) as credentialed by the American Academy of Professional Coders (AAPC).
Thorough knowledge of: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS, DRG and APC systems; E/M and procedure codes, modifiers, and NCCI edits; anatomy, physiology, disease pathology, and medical terminology necessary to correctly code diagnoses, procedures, and services; and Pro-Fee coding.
Working knowledge of: The Joint Commission standards for Medical Records Management and Clinical Documentation Programs.
Working Ability to: Code and abstract outpatient medical records and/or physician professional fees using ICD-10-CM, CPT, HCPCS, and applicable coding and reimbursement methodologies (such as PPS/APC).
Ability to: Communicate with all levels of professionals, including physicians; Train and educate providers on professional coding.

Responsibilities

Codes and abstracts, and reviews discharged outpatient medical records and physician professional services for a multi-specialty teaching facility using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System (ICD-10-PCS); Current Procedural Terminology (CPT); Health care Common Procedure Coding System (HCPCS); Prospective Payment System (PPS); and/or Diagnosis-Related Group (DRG) assignments based on Prospective Payment System (PPS) and/or Ambulatory Payment Classification (APC) methodologies; including Evaluation and Management codes (E/M), procedure codes, modifiers, National and Local Correct Coding Initiatives (NCCI) edits;
Examines and analyzes provider documentation and medical charts for completeness, accuracy, and relevancy in accordance with Federal and State regulations, ICD-10-CM Official Coding Guidelines and American Medical Association (AMA) guidelines;
Identifies the need for additional clinical documentation and sends queries to physicians for clarification on diagnoses and procedures performed to assign and/or validate the diagnosis or procedure code(s);
Conducts provider training and on-going education on billing guidelines and audits the work of non-facility coders;
Assists the Clinical Documentation Improvement (CDI) team with education CPT/HCPCS codes, billing guidelines and charge capture Outpatient ancillary department clinical staff;
Inputs completed patient data coding classification systems into the hospital’s Information Management System in accordance with The Joint Commission (TJC) and the Corporate Integrity Agreement between VCMC and the Office of the Inspector General;
May process fee-for-service physician claims and audit physician billing for contract compliance;
Identifies coding trends or issues and assists in resolving them;
Ensures codes meet payer-specific requirements and resolves denials;
Performs other related duties as assigned.