Outpatient Coding Specialist

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

JOB SUMMARY: The Coding Specialist II is responsible for accurately coding (ICD-10-CM, CPT, if applicable, Level I & II modifiers, if applicable) evaluation and management, surgery, emergency room, observation, injections and infusions, or coding edit and denials resolution.  May also code:  outpatient facility ancillary or clinic services. Will be working with multiple facility specific, state billing and coding guidelines as well as various Medicare Administrative Contractors nation-wide. 

ESSENTIAL JOB FUNCTIONS:

Project Work

• Outpatient Facility Coding (ER, OPS, OBS, Ancillary,  Clinic, etc.)
• Professional Clinic or Specialty Coding (E&M)
• Coding edits and denials resolution

Record Keeping

• Completion of Masterlog of accounts coded daily
• Completion of Time Allocation reports daily

Analysis/Reporting

• Identifies trends and reports to Coding manager
• Identifies daily work queues
• Identifies potential issues or errors

Customer Service

• Client liaison to communicate account inquiries

EDUCATION: High School or equivalent

EXPERIENCE

• Minimum of one year of experience in evaluation and management, surgery, emergency room, observation, injections and infusions, or denials. This should include hospital and/or physician practice.
• Coding Certifications: The following are recognized professional certifications:  Certified Professional Coder (CPC); Certified Outpatient Coder (COC); Certified Inpatient Coder (CIC); Certified Coding Specialist (CCS); or Certified Coding Specialist – Physician (CCS-P). Coding Specialist II coders are required to possess at least one of the above professional services coding certifications.  Continuing Education Requirements: Medical coders shall maintain the required continuing education hours in order to maintain current and proper national certification(s) requirements for this position.
• RHIA, RHIT certification accepted equivalent for all coding positions.
• Pass a pre-employment coding test that is provided, developed and administered by candidate management instructions.

OTHER HELPFUL EDUCATION OR EXPERIENCE

• An understanding of healthcare billing practices and compliant claims preparation for both governmental and commercial payers.
• Revenue Cycle Certifications:  The following are recognized professional certifications:  Certified Professional Account Representative (CPAR), Certified Revenue Cycle Representative (CRCR) or Certified Professional Biller (CPB).
• Electronic health record (EHR) expertise, including knowledge of a variety of vendors.
• Specialty Coding Certifications:  The following are recognized professional certifications:  Ambulatory Surgical Center (CASCC), Anesthesia and Pain Management (CANPC), Cardiology (CCC), Cardiovascular and Thoracic Surgery (CCVTC), Chiropractic (CCPC), Dermatology (CPCD), Emergency Department (CEDC), Evaluation and Management (CEMC), Family Practice (CFPC), Gastroenterology (CGIC), General Surgery (CGSC), Hematology and Oncology (CHONC), Internal Medicine (CIMC), Interventional Radiology and Cardiovascular (CIRRC), Obstetrics Gynecology (COBGC), Orthopedic Surgery (COSC), Otolaryngology (CENTC), Pediatrics (CPEDC), Plastics and Reconstructive Surgery (CPRC), Rheumatology (CRHC), Surgical Foot & Ankle (CSFAC), and Urology (CUC).

KNOWLEDGE, SKILLS and ABILITIES

• Ability to function independently and as a team player in a fast-paced environment required.  Responding to emails timely is a requirement. Knowledge of computing observation hours, when applicable.
• Knowledge of coding infusions and injections, when applicable 
• Knowledge of surgical coding.
• Must be able to maintain the company accuracy rating of 95%. 
• Must meet set weekly quota for productivity.  This is a production coding environment and very fast paced. 
• Knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM); Healthcare Common Procedure Coding System (HCPCS); and Current Procedural Terminology (CPT) including E&M.
• Resolution of coding related edits and denials (NCCI, NCD, LCD, MUE) with appropriate modifier application.
• Knowledge of reimbursement systems, including Prospective Payment System (PPS); Ambulatory Payment Classifications (APCs). 
• Must possess a working knowledge of Medicare and Local Medical Review Policy Guidelines, when applicable. Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
• Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology).
• Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
• Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis, procedure codes and modifiers.
• Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information. Speaking and writing (specifically email) in an organized manner is required.
• Display courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
• Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
• Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
• Be open to and embrace change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deals with uncertainty.  Cooperate by willingly accepting new assignments and forming relationships with customers/co-workers/supervisors.
• A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.
• Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations. Working Excel knowledge. 
• Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursement guidelines, and potential areas of risk for fraud.
• Work planning is necessary in being able to understand assignments and establish priorities.  It is required that each coder be able to look at his/her workload and determine priorities for the day. 

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.