Coding Specialist-Outpt

The purpose of this position is to correctly assign ICD-10-CM diagnostic/procedure CPT codes on clinical encounters in accordance with regulatory and CMS Official Guidelines for coding and reporting to ensure accurate reimbursement.

Nature and Scope Incumbent provides intermediate Clinical outpatient coding support through the Health Information Management department and works in conjunction with the Health Information Management leadership to complete all applicable coding assignments that can include Laboratory, Radiology, Emergency Department, Same Day Surgery, and Observation encounters. For compliance, this position must adhere to CMS Official Guidelines for Coding and Reporting. Intermediate outpatient coding staff must also have experience in one or more of these specialty outpatient areas including but not limited to, Recurring Wound Care, Injection Infusion Charging, Home Health, Hospice, Specialty Hospital Outpatient Departments and Pain Management.

Job Responsibilities The accurate assignment of ICD-10-CM diagnostic codes and procedural CPT codes by proficiently translating diagnostic statements, physician orders, and other pertinent documentation; leading to coding accuracy and abstracting of pertinent data elements from documentation provided to report and code for reimbursement. This position may also be responsible for identifying appropriate charges based on documentation and coding guidelines. When documentation or a valid order is incomplete, vague, ambiguous, or missing, it is the responsibility of incumbent to work in conjunction with HIM staff to utilize the appropriate physician clarification process to obtain additional information that provides a codable sign, symptom, or diagnosis and/or physician order.

Other Responsibilities

• Apply clinical knowledge of disease processes, physiology, pharmacology, and surgical techniques by reviewing and interpreting all clinical documentation included in an inpatient record.
• Adherence to Health Information Management (HIM) Coding policies.
• Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses, and procedures.
• Adherence to The Joint Commission (TJC) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.
• Responsibility for maintaining coding certification and knowledge referencing current ICD-10-CM coding guidelines and regulatory changes.
• Contacts the appropriate department or HIM staff member for assistance in obtaining physician clarification of diagnoses.
• Participates in performance improvement initiatives as assigned.
• Clarify physician documentation by utilizing facility-established query process.
• Demonstrates knowledge of sequencing diagnoses and procedure codes outlined in the ICD-10-CM Official Coding Guidelines, Uniform Hospital Discharge Data Set, CPT/HCPCS Coding Guidelines, AHA Coding Clinics, CMS guidelines, and other resources as applicable.
• May provide education and support to clinical areas in regard to appropriate documentation and code assignment.
• This position must consistently meet or exceed productivity and quality standards as defined by department Leadership.

KNOWLEDGE, SKILLS, AND ABILITIES

1. Knowledge of Anatomy and Physiology, Pharmacology, Disease Pathology, and Medical Terminology.
2. Knowledge of basic coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding.
3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural CPT codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
4. Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges.
5. Knowledge of clinical content standards.
6. Utilize critical thinking and problem-solving abilities.
7. Ability to work well with others.
8. Uphold a strong work ethic characterized by honesty and dependability.
9. Demonstrate personal time management skills, including organization, prioritization, and multitasking.
10. Adherence to company policies, procedures, and directives.

Disclaimer The foregoing description is not intended and should not be construed to be an exhaustive list of all responsibilities, skills, and efforts or work conditions associated with the job. It is intended to be an accurate reflection of the general nature and level of the job.

Minimum Qualifications

• Education: Must have working-level knowledge of the English language, including reading, writing, and speaking English. High School Diploma/GED required.
• Experience: A minimum of 2-5 years of outpatient coding experience is required. Experience in acute care facility outpatient and/or Trauma Level II coding preferred.
• License(s): Certification(s): CCS, CPC, and/or COC Coding credential required. (Excludes apprenticeship classification)
• Computer / Typing: Must be proficient with Microsoft Office Suite, including Outlook, Power Point, Excel, and Word. Must have the ability to use the computer to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.