Coding Specialist

Summary:
Reports to the Coding Manager. Reviews the outpatient clinical documentation of extract data and assign appropriate International Classification of Diseases Ninth Revision Clinical Modification (ICD-9-CM) and Current Procedural Terminology (CPT) codes in accordance with the outpatient ICD-9-CM Official Guidelines for Coding and Reporting and the American Hospital Association's (AHA) Healthcare Common Procedural Coding System (HCPCS).

 

Responsibilities:
Reads the medical record identifying all treated diagnoses and procedures reporting the correct code(s) adhering to rules set forth in �Official Coding Guidelines. Enters coded/abstracted information into 3M APC Pro or other encoder program in use by the hospital. Assigns accurate principal and secondary diagnoses and reviews all coding edits and adds modifiers as required for correct coding. Understands and follows all National Correct Code Initiative Edits (NCCI) and ensures that all diagnoses to support medical necessity requirements are coded per departmental policies. Resolves accounts on the claims edit database (CED). Assigns injections and infusion codes for clinic and/or observation patients. Must consistently meet minimum coding productivity and quality standards.



Assigns ICD-9-CM CPT or chargemaster service codes ensuring medical record documentation supports the code. Ensures codes entered on superbills or in the clinical system are accurate and supported by documentation in the medical record. Utilizes 3M or other software to identify and resolve NCCI edits before final billing. Reports documentation insufficiencies to the responsible physician.



Follows The Miriam Hospital Facility Coding Guidelines for hospital outpatient services POS 22 and uses 1995 Evaluation and Management Guidelines for office based settings POS 11.



Monitors and resolves rejected accounts on the Claims Edit Database (CED) and other reports by established timeframe researching coding conflicts including chargemaster medical necessity and various other coding and billing issues. Refers complex coding issues to the coding validator or manager.



Reviews pertinent outpatient uncoded reports researching and resolving old uncoded accounts and any accounts posted on reports for which the charges are inappropriate. Updates patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follows established procedures for rebilling accounts.



Confers with physician for clarification as needed. Monitors outpatient uncoded report to ensure timely coding and billing process. Maintains and meets coding quality and productivity standards.



Performs related duties as required.

 

Other information:
BASIC KNOWLEDGE:

Associate�s degree in health information technology or other related field with training in anatomy physiology and disease processes or the successful completion of an accredited coding certification program. Familiarity with and understanding of the content of the medical record. Ability to recognize and understand clinical documentation pertinent for coding. Coding certification required from the American Health Information Management Association (AHIMA) preferred - Registered Health Information Technician (RHIT) Certified Coding Associate (CCA) Certified Coding Specialist (CCS) or Certified Coding Specialist Physician-base (CCS-P) or from the American Academy of Professional Coders (AAPC) � Coder Physician Practice (CPC) or Coder Outpatient/Hospital Facility CPC-H).



EXPERIENCE:

1-2 year's experience in outpatient coding in a hospital setting clinic physician's office or health information management department. Ability to meet and maintain established quality and productivity standards. Ability to access recognize and read appropriate electronic and/or paper documents for coding.



At least twelve (12) continuous months as a regular part-time or full time employee at the hospital and the employee must have established a record of performance determined to be suitable for telecommuting that meets or exceeds all job requirements. Employee has no recorded poor performance criterion needing improvement and has had no corrective action plan within six months prior to the start of any telecommuting arrangement.



WORKING CONDITIONS:

Reads medical records for the entire workday. Ability to sit for long periods of time using a keyboard mouse and dual computer monitors. Ability to work under stressful conditions to maintain accounts receivable days while achieving productivity and accuracy standards.



SUPERVISORY RESPONSIBILITY:

None.

 

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status.   Lifespan is a VEVRAA Federal Contractor.

 

Location: The Miriam Hospital USA:RI:Providence

 

Work Type: Full Time

 

Shift: 1

 

Union: Non-Union