Outpatient Coder II

UMass Memorial Health•Worcester, MA

1d•$23 - $41

About The Position

Interprets a wide variety of clinical and diagnostic documentation to process hospital and/or professional-fee charges for episodes of outpatient care. Assigns appropriate current-edition ICD-CM and CPT codes and modifiers, and, depending on account type, may assign ICD-PCS codes in accordance with official coding guidelines. The position reviews medical records and related tests and reports, verifies that documentation supports assigned codes, and helps resolve incomplete or missing chart documentation to expedite coding and billing. The coder participates in ongoing coding audits, performance management, improvement efforts, and documentation training for medical and clinical staff. The role is expected to maintain at least 95% coding accuracy and meet department productivity standards. The coder keeps current with coding updates, regulations, and guidelines; attends required training and coding in-services; communicates with coding colleagues and management about backlogs, documentation problems, unusual situations, and coding irregularities; and follows applicable AHA, AMA, and CMS coding and billing regulations.

Requirements

High school diploma or equivalent.
Knowledge of current-edition ICD-CM and CPT coding systems, as well as CCI edits.
Knowledge of third-party payer requirements and federal and state guidelines and regulations related to coding and billing practices.
Good interpersonal and communication skills, with professionalism.
Good customer service skills and the ability to communicate efficiently.
Good organizational skills and attention to detail.
Ability to work independently within established guidelines.
Ability to organize and coordinate multiple functions and tasks.
Ability to problem-solve, organize, and prioritize workload to meet productivity benchmarks.
Ability to withstand ongoing pressure and deal with individuals tactfully, discreetly, and diplomatically.

Nice To Haves

Medical coding certification.
Training in medical terminology from an accredited program, with completion and passing of a certification program within one year of hire; recognized programs include AHIMA and AAPC.
Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P) certification.
Three years of medical abstraction and outpatient coding experience or related work experience.

Responsibilities

Review medical records, tests, and reports to determine appropriate ICD-CM and/or CPT codes and modifiers; assign ICD-PCS codes when appropriate based on account type and official coding guidelines.
Verify that documentation substantiates assigned codes.
Help resolve incomplete or missing chart documentation to expedite coding and billing.
Participate in the continuous coding audit and performance management program.
Maintain a coding accuracy rate of at least 95% and meet department productivity standards.
Attend required annual training classes and coding in-services to stay current with regulations and coding guidelines.
Participate in improvement efforts and provide documentation training to medical and clinical staff related to coding practices and guidelines.
Notify the Manager when backlogs arise or necessary documents are incorrect or delayed.
Refer unusual or questionable situations to the direct Manager.
Alert management to coding irregularities or trends contrary to policies and procedures.
Follow coding and billing regulations established by the AHA, AMA, and CMS.
Communicate on an ongoing basis with other coding personnel to support the effectiveness and efficiency of operations.
Keep current with coding updates and information related to correct coding.