Speciality Outpatient Coder

OP Coder will competently assign ICD-10CM or CPT-4 codes to more complex outpatient accounts for billing, internal and external reporting, research, and regulatory compliance. Utilizes an encoder and computer assisted coding (CAC) software to achieve accurate and thorough coding. Is responsible for assigning DRG assignment, APC weights, resolving medical necessity edits, and extracting data for the medical record abstract. Queries physicians on documentation needed for coding. Researches complex coding scenarios. OP Coder analyzes clinical documentation; assign appropriate diagnosis, procedure, and, in some cases, level of service codes; and abstracts the codes and other clinical data. This information is then used to determine reimbursement levels, assess quality of care, study patterns of illness and injuries, compare healthcare data between facilities and between physicians, and meet regulatory and payer reporting requirements.

• Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards.
• Actively participates in creating and implementing improvements.
• Assigns ICD-10-CM or CPT codes to all diagnoses, treatments, and procedures on complex hospital outpatient or department visits.
• Is able to research and understand simple and moderately complex coding issues.
• Validates computer assisted coding (CAC) generated and suggested codes in conjunction with encoder. Is proficient in using various coding software. Is able to problem solve simple computer issues.
• Utilizes technical coding principals and/or APC reimbursement expertise to assign appropriate ICD-10-CM diagnoses and CPT procedures. Assigns modifiers to CPT codes.
• Extracts required information from electronic medical record and enters into encoder and abstracting system.
• If applicable, identifies chargeable items for department visits and enters into computer system.
• Follows-up on unabstracted accounts to assure timely billing and reimbursement.
• Resolves any questions concerning diagnosis, procedures, clinical content of the chart or code selection through research and communication.
• May query physicians on documentation according to established procedures and guidelines.
• Meets productivity and quality standards as established by coding managers.
• Educate multidisciplinary team members, including physicians, about frequently changing mandated rules, regulations and guidelines to ensure a complaint claim.
• Identify and resolve clinical documentation and charge capture data discrepancies to improve quality of the clinical documentation, severity and reimbursement levels assigned, integrity of data reported
• Meet departmental quality and productivity standards
• Performs other responsibilities as needed/assigned.

Required