Pre-Bill Coder Specialist - Outpatient

American Addiction Centers•Milwaukee, WI

2d•$28 - $42•Remote

About The Position

Will support: Responsible for performing informal coding accuracy reviews of outpatient encounters prior to billing, with a focus on cases involving high risk CPT codes and Inpatient Only (IPO) CPT codes. This role supports coding accuracy, regulatory compliance, and revenue capture by identifying errors and providing constructive feedback to coders to improve overall accuracy and consistency. Specialists analyze and validate pre billing edits, including but not limited to LCD/NCD edits, unspecified code edits, and modifier related edits—to promote coding accuracy, compliance, and alignment with CMS guidance. Schedule: Monday - Friday 1st shift 40 hours a week. Certification desired: Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range $28.05 - $42.10 Prioritizes and codes and abstracts high dollar charts, day after discharge, as well as interim charts, at regular intervals, with a high degree of accuracy. Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes utilizing ICD CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Assigns codes for present on admission, research, Hospital acquired Conditions and Core Measure Indicators for all diagnoses both concurrently and post-discharge. Collaborates with other departments to clarify pre-bill coding documentation issues such for inpatient and outpatient to insure reimbursement and clinical outcomes. Works claim edits for all patient types and may codes consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios. Completes informal peer-review on inpatient and outpatient coders. Tracks and trends quality information from internal and external sources to partner with the educational team on opportunities. Communicates with Medical Staff, CDI, Post -bill for documentation clarification. Utilizes EMR communication tools to track missing documentation on inpatient queries that require follow-up to facilitate coding in a timely fashion. Partners with HIM, Patient Accounts, and Integrity, when needed, to help resolve issues affecting reimbursement and outcomes. Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for coding all types of patients. Must be able to use critical decision-making skills to determine when to query to clarify documentation independently for outcomes, reimbursement and benchmarking.

Requirements

Must have a certification through American Health Information Management Association (AHIMA) or American Academy of professional Coders (AAPC)
Two Year associate degree or equivalent work experience
Five to Seven years of inpatient coding experience in an acute care inpatient setting in an Academic Inpatient Care Tertiary Facility
Advanced profiency of ICD, CPT and HCPCS coding guidelines.
Advanced knowledge of medical terminology, anatomy and physiology.
Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
Excellent communication (oral and written) and interpersonal skills.
Excellent organization, prioritization, and reading comprehension skills.
Excellent analytical skills, with a high attention to detail.
Ability to work independently and exercise independent judgment and decision making.
Ability to meet deadlines while working in a fast-paced environment.
Ability to take initiative and work collaboratively with others.

Responsibilities

Prioritizes and codes and abstracts high dollar charts, day after discharge, as well as interim charts, at regular intervals, with a high degree of accuracy.
Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes utilizing ICD CM/PCS, CPT, and HCPCS.
Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
Assigns codes for present on admission, research, Hospital acquired Conditions and Core Measure Indicators for all diagnoses both concurrently and post-discharge.
Collaborates with other departments to clarify pre-bill coding documentation issues such for inpatient and outpatient to insure reimbursement and clinical outcomes.
Works claim edits for all patient types and may codes consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
Completes informal peer-review on inpatient and outpatient coders.
Tracks and trends quality information from internal and external sources to partner with the educational team on opportunities.
Communicates with Medical Staff, CDI, Post -bill for documentation clarification.
Utilizes EMR communication tools to track missing documentation on inpatient queries that require follow-up to facilitate coding in a timely fashion.
Partners with HIM, Patient Accounts, and Integrity, when needed, to help resolve issues affecting reimbursement and outcomes.
Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for coding all types of patients.
Must be able to use critical decision-making skills to determine when to query to clarify documentation independently for outcomes, reimbursement and benchmarking.

Benefits

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:
Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Benefits and more Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program