Specialist Outpatient Coder- Remote

Job Description

The Outpatient Specialty Medical Coder is responsible for coding outpatient records, Facility, and/or Professional, for the purpose of reimbursement in compliance with federal, state, and regulatory agencies’ guidelines using the most current taxonomic and classification systems. Performs coding, charge entry, and charge review including but not limited to, reviewing clinical documentation, appending modifiers and/or correcting edits. The Outpatient Specialty Medical Coder I will be responsible for coding the following services: Non Centra Medical Group (CMG) Endoscopy, Orthopedic Surgery, Gynocologic Surgery, Surgical Observation, General Surgery, Plastic Surgery, Neurosurgery, Urology, Bariatric Surgery, and Pain Management.

Responsibilities

Reviews clinical documentation and assigns appropriate outpatient facility and/or professional codes, reviews/posts charges for the purpose of reimbursement, research, and compliance in accordance with International Classification of Diseases, tenth revision, Clinical Modification (ICD-10-CM), Healthcare Common Procedures Coding System (HCPCS_ and Current Procedure Terminology (CPT) coding guidelines.

Accurately extracts clinical information from records according to established requirements using abstracting software.

Interprets coding rules and general policies in addition to determining appropriate conclusions.

Complies with all federal, local, and other legal requirements as they relate to medical coding practices.

Submit coding queries, as needed, per coding guidelines and Centra policy and participate in physician education, as needed.

Maintain worklists for Professional coding for reconciliation of charges and reporting to CMG office staff and providers.

Resolves National Correct Coding Initiative (NCCI) and medical necessity edits in the 3M Coding and Reimbursement System to ensure clean claim submission.

Reviews Outpatient Specialty 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 and coding. Determines appropriate action needed to resolve coding edits/issues and ensure clean claim submission.

Research and resolve charge review, claim edit, and denials; asks assistance from higher level staff on more complex issues.

Maintains productivity and accuracy standards set by Centra.

Ensures assigned queues are worked timely and efficiently.

Maintain coding education requirements and appropriate certifications.

Observes confidentiality and safeguards all patient related information.

Communicates in a positive and professional manner with patients, physicians, and staff.

Demonstrated home office skills including PC use and maintenance, knowledge of Microsoft Office products including Excel and Outlook.

Demonstrates ability to work independently.

Demonstrates ability to adjust to changes in workflow.

Thoroughness and attention to detail

Performs other duties as assigned.

Qualifications

Required Qualifications:

Coding certification: Certified Professional Coding Certification (CPC) (CPC-H), (CPC-P); or Certified Coding Specialist (CCS) or other related American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) certification.

Completion of coding training program to include anatomy & physiology, medical terminology, basic ICD-10 diagnostic and basic CPT procedural coding.

Minimum 5 Years Of Facility And/or Professional Coding Experience.

Demonstrated proficiency in ICD-10-CM, CPT, and HCPCS I &II coding systems by passing coding competency assessment administered before hire.

Demonstrated proficiency in medical terminology, anatomy and physiology, and disease process by passing coding competency assessment administered before hire.

Good working knowledge of Outpatient Prospective Payment System (OPPS), Ambulatory Payment Classifications (APC), National Correct Coding Initiative Policy (NCCI) and Medicare Physician Fee Schedule (MPFS).