Outpatient Coder II

UMass Memorial Health•Worcester, MA

About The Position

Interprets a wide variety of clinical and diagnostic documentation in order to process hospital and / or pro-fee charges for episodes of outpatient care. Assigns appropriate ICD-CM (current edition) and CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as appropriate adhering to official coding guidelines.

Requirements

High School diploma or equivalent
Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits
Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
Good interpersonal and communications skills and demonstrates professionalism
Good customer service skills with the ability to communicate efficiently.
Good organizational skills with 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 significant level of on-going pressure, and ability to deal with individuals with tact, discretion and diplomacy.

Nice To Haves

Medical coding certification
Training in medical terminology from an accredited program, completing and passing certification program within one year from date of hire. (Recognized programs include: American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).
Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P)
Three (3) years of medical abstraction and outpatient coding experience or related work experience

Responsibilities

Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as defined by official coding guidelines and other recognized reference materials.
Verifies documentation is present to substantiate codes assigned.
Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
Participates in the continuous coding audit and performance management program.
Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
Communicates to Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
Refers all unusual, questionable situations to the direct Manager.
Alerts management to any coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken.
Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
Keeps current with all coding updates and information related to correct coding.