Location: Steward Health Care
Posted Date: 5/22/2023
(Briefly describe the overall purpose of this position - Why does it exist and how does it contribute to the overall organization?)
The Outpatient denials coder shall review hospital outpatient medical documentation to validate the appropriate ICD-10-CM, CPT, HCPCS codes with outpatient encounters to ensure proper coding, billing, and compliance for both pre and post payment denials.
(Use bullets for specific responsibilities)
- Reviews encounters to validate appropriate diagnoses and procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
- Using 3M encoder, reviews Ambulatory Payment Classifications (APC) and coding edits. Reviews Local/National Coverage Determination (LCD/NCD) edits and guidance for codes meeting medical necessity. Research electronic medical records for any additional diagnoses documented to meet medical necessity.
- Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
- Reviews all appropriate work queues daily to address edits and make corrections per SHC coding procedures.
- Routes to billing charge entry errors and/ or account edits.
- Makes appropriate coding corrections when advised and follows procedure to notify billing.
- Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding.
- Meets and maintains HIM coding quality and productivity standards.
- Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
- Enhances and maintains coding knowledge and skills.
- Ability to perform coding across multiple locations based on corporate management need.
- Technology skills to adapt to multiple applications used within the organization.
- Candidate must display a superior knowledge of Coding Guidelines (Coding Clinic, UHDDS Official Coding Guidelines, CCI Edits).
- Ability to maintain 95% or greater accuracy rate.
- Knowledge of physician query in an outpatient setting
- Candidate must have experience with 3M360 encompass.
- Candidate must be self-motivated, display a high level of computer literacy, excellent verbal, and written communication skills, able to meet assigned deadlines, and organized.
- The position will report to the HIM Outpatient Coding Manager
REQUIRED KNOWLEDGE & SKILLS:
(Examples: Ability to work independently and take initiative; Good judgment and problem-solving skills; Communication skills; Interpersonal and organizational skills; Level of confidentiality)
- Minimum 5 years of outpatient coding experience
- Minimum 3 years of experience working denials in the outpatient facility setting.
- FinThrive Experience, preferred.
- Comprehensive understanding of UHDDS guidelines, CCI Edits, Coding Clinic, etc.
- Meditech experience preferred.
- Microsoft Office (Word, One Note, Excel, Outlook, PowerPoint)
- Excellent verbal and written communication skills
- Ability to meet assigned deadlines.
- Education: Associate degree preferred
- Experience: 5 years of Outpatient coding for all outpatient work types in an acute care setting.
- Certification/Licensure: CCS and/or CPC certification
- Software/Hardware: 3M experienced required, Meditech experience preferred, FinThrive experience preferred
- Other: Remote position