Reviews medical record documentation to assign ICD-10-CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.
Responsibilities include:
- Reviewing Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments using encoder tools.
- Reviewing coding edits, Local Coverage Determination (LCD) edits, and medical necessity guidance.
- Researching the electronic medical record for additional diagnoses documented to support medical necessity.
- Coding outpatient service lines across multiple specialties, including high-complexity surgical procedures and anesthesia procedure codes, following payer requirements.
- Reading and interpreting provider documentation from dictated, scanned, electronic, imaging, pathology, and lab records.
- Reviewing work queues daily to address edits and make corrections following HIM coding policies and procedures.
- Conducting audits and coding reviews with healthcare professionals to ensure documentation accuracy for physician billing.
- Communicating with insurance companies regarding coding errors and disputes.
- Reviewing and validating Admission-Discharge-Transfer (ADT) data fields.
- Reviewing discharge disposition documentation and requesting clarification when needed.
- Attending educational meetings and seminars to maintain certification and continuing education requirements.
- Assigning and sequencing diagnoses, including HCC coding, and CPT procedure codes for complex diagnostic and surgical encounters.
- Seeking clarification from providers to ensure accurate and complete coding.
- Creating electronic physician queries within the allowed scope for hospital outpatient coding.
- Routing billing charge entry errors and account edits that prevent coding and/or billing completion.
- Making coding corrections when advised and notifying billing as appropriate.
- Reviewing chargemaster-generated CPT/HCPCS codes and notifying coding management when errors are found.
- Practicing ethical coding in accordance with AHIMA standards.
- Meeting coding quality and productivity standards and submitting daily productivity reports.
Requirements & Qualifications
High school diploma or equivalent required.
Required experience:
- Two years of hospital-based outpatient coding experience, or completion of the internal MHS Coder Intern Program for HIM coder candidates.
- Two years of higher-complexity diagnostic, procedural, or office coding experience for Physician Billing coder candidates.
Required knowledge and skills:
- Strong knowledge of medical terminology, anatomy and physiology, pathophysiology, and pharmacology.
- Understanding of coding classification systems and procedures.
- Ability to review, research, and code diagnoses and procedures with a high level of complexity.
- Proficiency with basic computer applications, encoder tools, and electronic medical record systems.
- Ability to work independently with minimal supervision and use critical thinking in a stressful environment.
- Strong communication skills and attention to detail.
Preferred certifications may include:
- CCS
- RHIT
- RHIA
- CPC
- CPMA
- CRC
- CCSP
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
2 weeks ago
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