Outpatient Specialty Coder

Role Overview

• Responsible for critical access hospital coding including emergency department, infusions, Critical Access Hospital Specialty Clinic, professional fees, and Rural Health Clinic
• Ensure the timely and accurate coding of medical claims while maximizing reimbursement for services
• Receive and review charge entry data from practice sites
• Identify and investigate incomplete or missing charges
• Abstract clinical information; translates medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems
• Sequence codes according to established guidelines
• Thorough analysis and interpretation of medical information, medical diagnoses, coding/classification systems, to ensure accuracy for prospective payment system reimbursement
• Maintain current knowledge of coding rules and regulations as designated by the AMA, Centers of Medicare and Medicaid Services (CMS) and other payers
• Maintain proficient knowledge of EHR, as well as any other systems to perform job duties
• Communicate issues to management, including payer, system, or escalated account issues
• Identify medical necessity denial trends and provide suggestions for resolution
• May perform other billing functions including claim submission, unpaid claims follow-up, denial resolution
• Participation in department meetings, in-service programs, and continuing education programs
• Convey professional attitude with patients, visitors, physicians, office staff and hospital personnel
• Assure confidentiality of patient information, maintaining compliance with policies and procedures
• Perform other duties as assigned

Requirements

• High School Diploma or GED
• required
• Associate Degree
• preferred
• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS)
• required
• Three to five years in emergency room coding, infusion coding, specialty clinic procedure coding
• preferred
• Two years’ experience with formal coding training
• considered
• Knowledge of medical terminology
• required
• Critical Access Hospital and/or Rural Health Clinic coding is a plus
• Proficient with Microsoft Office
• Demonstrated strong verbal and written communication skills
• Ability to use multiple client systems and manage competing priorities

Benefits

• Professional development
• Continuing education programs