Outpatient Coding Specialist II (Remote)

Stanford Health Care•Hubley Township, PA

8d•$52 - $59•Remote

About The Position

Intermediate coding position that reviews clinical documentation and diagnostic results as appropriate to extract data and assign the appropriate International Classification of Diseases (ICD-10-CM/PCS) codes, CPT codes with modifiers, as well as grouping of Ambulatory Payent Classifications (APCs) for billing, internal and external reporting, research, and regulatory compliance. This position codes most (a minimum of three) types of outpatient records (for example, diagnostic, therapeutic, emergency department services, ambulatory surgery/same day surgery and observation service encounters) and follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of Ethical Coding as well as all American Hospital Association (AHA) Coding Clinics for HCPCS and the AMA CPT Assistant. Follows Stanford Health Care policies and procedures and maintains required quality and productivity standards. Reviews, abstracts and assigns technical and ethical ICD-10-CM/PCS and Current Procedural Terminology (CPT) codes with modifiers to outpatient services. Ensures compliance with third party, State and Federal regulations. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures and other services provided. Obtains missing information and/or clarifies existing information. Completes volume of work from work queues per departmental productivity standards. Groups codes and completed product. Analyzes information for optimal and proper reimbursement. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. Utilizes Epic, 3M Coding and Reimbursement System (Encoder), 3M CDIS, 3M Audit Expert, MS Office, and other software as appropriate to compile and validate medical information. Responsible for validating and working any medical necessity edits that apply in the coding of the outpatient accounts, any error reports associated with revenue cycle process, for identifying and reporting error patterns, and, when necessary, assisting in design and implementation of workflow changes to reduce billing errors

Requirements

High School Diploma or GED
Three years, must be able to code most (at least 3) outpatient services
Successful completion of the Coder Proficiency Exam (pre-hire)
Ability to adapt to and deal with change and ambiguity
Ability to plan, organize, prioritize, work independently and meet deadlines
Ability to comply with the American Health Information Management Association’s Code of Ethics and Standards and apply Uniform Hospital Discharge Data Set (UHDDS) standards
Ability to establish and maintain effective working relationships
Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
Ability to solve technical and non-technical problems
Ability to utilize the ICD-10-CM/PCS and CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record documentation; assign accurate codes for grouping of MS-DRG’s and APR-DRG’s
Ability to work effectively through and with others
Knowledge of diagnosis/procedure DRG grouping schemes such as MS-DRGs and APR-DRGs
Knowledge of health information systems for computer application to medical records
Ability to foster effective working relationships and build consensus
Ability to work effectively with individuals at all levels of the organization
Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues
Knowledge of computer systems and software used in functional area
Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
RHIA - Registered Health Information Administrator or
RHIT - Registered Health Information Technician or
CCS - Certified Coding Specialist or
CPC and/or CCSP - Certified Professional Coder or
COC

Responsibilities

Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, CPT codes and modifiers as applicable, leading to the assignment of the correct Ambulatory Payment Classification (APC). The Outpatient Coding Specialist II is responsible for validating and working any medical necessity edits that are applicable in the coding of the outpatient account. Additionally responsible for verification of the patient’s discharge disposition and correct source of admission for state reporting purposes.
If applicable to outpatient type responsible for coding, following established conventions and guidelines, codes and abstracts the medical records of day surgery and outpatient records. Assists with coding and leveling ERs as needed. Assists with coding and charging infusion cases as needed. Keeps work queues within established date goals.
Codes procedures as appropriate and identifies the principal procedure consistent with established coding guidelines.
Validates outpatient accounts for medical necessity based on local coverage determination policies (LCDs) or national coverage determinations (NCDs).
Applies charge data as appropriate for services provided.
Correctly abstract required data per facility specifications.
Responsible for monitoring Discharged Not Billed accounts, and as a team, ensure timely, compliant processing of inpatient accounts through the revenue cycle.
Collaborates with Clinical Documentation Specialists, (CDSs,) and members of the medical staff to ensure completeness of documentation in the medical records so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
Responsible to ensure accuracy and maintain established quality and productivity standards.
Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision. Exhibits strong time management, problem solving and communication skills.
Critical thinking, good judgment and decision making skills
Excellent written and oral communication skills
Remain abreast of current Centers for Medicare and Medicaid Services, (CMS) requirements as well as Correct Coding Initiative, (CCI) edits, Hospital Acquired Conditions, (HAC's), Patient Safety Indicators, (PSI’s), and when applicable, National Coverage Determinations, (NCDs) and Local Coverage Determinations, (LCDs,) including the addition of appropriate modifiers to ensure a clean claim the first time through.
Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, 3M Audit Expert process, (3M AES,) 3M Clinical Documentation Improvement System, (3M CDIS,) and abstracting systems, and all reference materials.
Follows all established Stanford Health Care policies and procedures.
Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.
Employees must abide by all Joint Commission requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients’ rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings.
Employees must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions.