Single Path Coding Specialist II (Remote)

Stanford Health Care

20h•$60 - $68•Remote

About The Position

The Single Path Coding (SPC) Specialist-Level 2 is an advanced coder position responsible for reviewing clinical documentation to extract data and assign appropriate International Classification of Diseases 10th Edition Clinical Modification (ICD-10-CM) diagnostic codes, Current Procedural Terminology (CPT) procedure codes and modifiers, group Ambulatory Payment Classifications (APCs) for billing, and process National Correct Coding Initiative (NCCI) and payer specific edits related to hospital and professional coding. The Single Path Coder processes codes for surgical encounters and follows the ICD-10-CM 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 American Medical Association (AMA) CPT Assistant. The SPC Coding Specialist II serves as a subject matter expert in hospital and professional coding, and interacts with other teams and departments across the organization such as Patient Financial Services, the Patient Billing Office, the Revenue Integrity (Charge Description Master) Team, provider teams and/or Compliance on a routine basis. Additionally, this position interacts with physicians, DFA's, clinical mangers and many other clinical roles throughout the enterprise. The SPC Coding Specialist follows Stanford Health Care policies and procedures and maintains required quality and productivity standards while remaining compliant with third party, State and Federal regulations. In addition to traditional coding related activities, responsibilities also include reviewing and resolving medical necessity edits that may apply for any outpatient surgical encounters, applying hospital and professional modifiers to CPT codes, processing any errors associated with the revenue cycle process, and collaborates on summarizing findings for provider documentation optimization opportunities. When necessary, the SPC Coding Specialist may assist in the design and implementation of workflow changes to reduce coding and billing errors. The SPC Coding Specialist II is distinguished from SPC Coding Specialist I by mastering more than one specialty and/or possessing coding certification in two specialties.

Requirements

Associate Degree in work -related discipline/field or equivalent combination of education and work experience
Five years; must be proficient in coding surgical encounter specialties
Currently holds role-related certifications RHIA, RHIT, CCS, CCS-P, CPC, or COC or other coding certification in specialized area OR CIRCC for advanced knowledge of Interventional Radiology and Interventional Cardiology coding
Successful completion of the Coder Proficiency Exam (pre-hire)
Ability to consistently meet department’s quality and productivity standards
Ability to develop and maintain supportive, collaborative relationship with Physicians and other clinical professionals
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
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
Ability to work effectively through and with others
Knowledge of APC grouping methodology
Knowledge of health information systems for medical records (Epic and 3M 360e Computer Assisted Coding)
Ability to foster effective working relationships and build consensus
Ability to work effectively with individuals at all levels of the organization
Knowledge of NCCI and other CMS compliance issues
Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and disease processes
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-CM diagnoses, CPT codes and modifiers as applicable for both the hospital and professional claim
Validate and process any medical necessity edits (local or national coverage determinations) that may apply for hospital and professional coding
Process coding-related payer specific edits for the hospital and professional claim
Communicates effectively with provider teams across the organization; serve as an advocate for documentation improvement
Follow established coding conventions and guidelines as set forth by State and Federal regulations
Responsible for monitoring Discharged Not Billed accounts, and as a team, ensure timely, compliant processing of outpatient and inpatient encounters through the hospital and professional revenue cycle
Responsible for maintaining 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, NCCI edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), payer specific edit processing required to ensure clean claim submission for both the hospital and professional
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.