The Hospital Outpatient Coder II is responsible for coding Recurring Provider Based Billing (PBB) , Outpatient Diagnostic, Specialty Outpatient Diagnostic, Medical Observation and Emergency Department encounters for the purpose of reimbursement, statistical analysis, and other clinical purposes in compliance with federal, state, and regulatory agencies’ guidelines using the most current International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) and Current Procedural Terminology (CPT) classification systems. Performs clinical documentation review, coding, charge entry, and charge review that includes appending modifiers to resolve claim edits. The Hospital Outpateint Coder II will be skilled in coding all services of Hospital Outpatient Coder I and be responsible for coding the following services: , Cardiology, PET Scans, Infusion Therapy, Maternity/Newborn, Radiation Oncology, Recurring PBB locations to includue Hematology/Oncology and Wound Care Center, Respiratory, and Pediatrics, Medical Observation, Emergency Department admits and dispositioned.
Reviews clinical documentation and assigns appropriate Outpatient Diagnostic ICD-10-CM and/or CPT codes using 3M Coding and Reimbursement software.
Reviews clinical documentation and assigns appropriate Emergency Department facility and professional Evaluation and Management levels and procedures with appropriate ICD-10-CM and/or CPT codes for the purpose of reimbursement using 3M coding and reimbursement software. Coding includes Infusion and Injection administration charges.
Reviews clinical documentation and assigns appropriate Medical Observation ICD-10-CM and/or CPT codes using 3M Coding and Reimbursement software.
Reviews clinical documentation and assigns appropriate Medical Observation professional Evaluation and Management level with appropriate ICD-10-CM and/or CPT codes for the purpose of reimbursement using 3M Coding and Reimbursement software.
Reviews clinical documentation and assigns appropriate Infusion and Injection administration charges.
Submit coding queries, as needed, per coding guidelines and Centra policy and participate in physician education, as needed.
Resolves National Correct Coding Initiative (NCCI) and medical necessity edits in the 3M Coding and Reimbursement System to ensure clean claim submission.
Reviews Medical Observation and Emergency department claims in assigned work queues in Cerner Revenue Cycle.exe. Analyzes coding edits, reviews timeline notes, reviews clinical documentation, including nursing notes, provider orders, progress notes, surgical and test results thoroughly to interpret and ensure documentation supports the posted charges. Determines appropriate action needed to resolve coding edits/issues and ensure clean claim submission.
Ensure assigned queues are worked timely and efficiently.
Maintains productivity and accuracy standards set by Centra.
Reports coding and documentation concerns, trends, and issues to leadership for investigation and resolution.
Maintains coding education requirements for required coding certifications.
Works closely with outpatient coding team, managers, and other co-workers. Communicates in a positive and professional manner.
Other Functions:
Observes confidentiality and safeguards all patient related information.
Remote home office skills including PC use and maintenance, knowledge of Microsoft Office products including Excel and Outlook.
Performs other duties as assigned.
Required Qualifications:
Certified Professional Coding Certification (CPC), Certified Coding Specialist (CCS) or other related AHIMA, AAPC coding credential
Minimum 2 years hospital outpatient coding experience
Demonstrates working knowledge of ICD-10-CM, CPT, and HCPCS I &II coding systems by passing coding competency assessment administered before hire
Demonstrates working knowledge in medical terminology, anatomy and physiology, and disease process by passing coding competency assessment administered before hire.
Working Knowledge of Outpatient Prospective Payment System (OPPS) and Ambulatory Payment Classifications (APC)
Preferred Qualifications:
Associates degree
5+ years hospital outpatient coding experience
Proficient in Microsoft applications including Word and Excel.
Travel Required
Travel is expected to be between 0% - 10% of the time].
Travel may be needed occasionally for training and or other educational opportunities.
Read Full Description