Outpatient Health Information Coding and Reimbursement Specialist

Cape Cod Healthcare•Hyannis, MA

10d•Onsite

About The Position

This role involves assigning, analyzing, sequencing, and validating codes based on medical record documentation using automated encoders, books, and other coding compliance and reimbursement resources. The specialist will demonstrate a complete understanding of Official Coding Guidelines, CCI edits, anatomy, physiology, and medical terminology to appropriately code complex outpatient encounters, including oncology/infusion clinics, outpatient surgery, and observation encounters. Responsibilities include reviewing medical record documentation to assign diagnoses, procedures, level codes, and modifiers for accurate hospital reimbursement, and entering/updating charges with correct procedure codes, dates of service, and modifiers. The role ensures coding compliance, regulatory, and reimbursement requirements are met, abstracts pertinent information into the coding abstracting and hospital billing systems, and queries physicians for additional or clarified documentation. The specialist will reconcile medical records within work queues to meet departmental goals, maintain a 95% ongoing accuracy rate, and achieve weekly coding output within minimal productivity standards. Self-management of workflow for timely claim submission and productivity is essential. The role also involves assisting in the orientation of new personnel, pursuing professional development for skill enhancement and certification maintenance, and continuously monitoring systems and workflows to identify and resolve problems related to errors and compliance. Communication with the Coding Manager for solutions and improvements is key, as is reviewing and completing system edits and denials daily, and notifying the manager of trends. The position requires performing duties in accordance with the Hospital's Customer Service standards, providing service excellence, and performing other assigned duties.

Requirements

Ability to read, write and communicate in English.
Active CCS (AHIMA Certified Coding Specialist), CPC (AAPC Certified Professional Coder), RHIT (AHIMA Registered Health Information Management Technician), or COC (AAPC Certified Outpatient Coder).
Successful passage of Medical Record Department Outpatient Coding Exam, demonstrating understanding of coding and impact on reimbursement with a grade of 80% or better.
At least 1 year of acute care hospital coding experience for complex outpatient encounters, including but not limited to clinics such as oncology/infusion clinics, outpatient surgery, observation encounters including infusion and injection procedures.
Minimum 6 months of PC windows experience.

Responsibilities

Assigns, analyzes, sequences, and validates codes based on medical record documentation using the automated encoder, book and other coding compliance and reimbursement resources.
Demonstrates complete understanding of Official Coding Guidelines, CCI edits, anatomy, physiology, and medical terminology to appropriately code complex outpatient encounters.
Reviews all medical record documentation to determine and assign diagnoses, procedures, level codes and modifiers, to ensure appropriate coding for hospital reimbursement.
Reviews the appropriate documentation to enter/update charges as necessary in order to apply the correct procedure code(s), date of service, appropriate modifiers.
Ensures that coding compliance, regulatory and reimbursement requirements are met.
Abstracts pertinent information into the coding abstracting system and hospital billing system as needed.
Assesses adequacy of documentation and queries physicians and other healthcare providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding and hospital reimbursement.
Reconciles medical records to be coded within work queues to maintain or exceed established fiscal departmental goals, and in accordance with departmental procedures.
Maintains a 95% ongoing accuracy rate based on Medical Record Department performance monitors, third party validation audits and internal/external coding audits.
Consistently achieves weekly coding output within the minimal productivity standards set by HIS management.
Self-manages and prioritizes work flow to achieve timely submission of claims and optimal coding productivity standards.
Maintains accurate productivity logs and provides this information to the Coding Manager in a timely fashion.
Assists in the orientation and development of new coding personnel.
Assumes professional responsibility for development of skills and ongoing education to maintain active coding certification.
Remains abreast of developments in health information management by pursuing a program of professional development, attending educational programs and meetings and reviewing pertinent literature.
Continuously monitors medical record documentation, coding and patient financial computer systems, individual performance and department workflow as related to the coding function to identify problems and potential solutions (especially related to errors and compliance issues).
Communicates with the Coding Manager to find solutions and implement changes to increase productivity and department efficiency.
Reviews and completes system and coding edits and denials on daily basis.
Notifies Coding Manager of trends to aid in resolution of payor, performance or reimbursement issues.
Performs all duties and interacts with others in accordance with the Hospital's Customer Service standards.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
Perform other work related duties as assigned or requested.