Position Summary / Career Interest:

The HIM Outpatient Surgery/Ambulatory Coder is responsible for reviewing outpatient/inpatient EHR. This position monitors CPT, ICD-10, and HCPCS code changes. Audits and/or assigns codes (CPT, HCPCS, and diagnosis) for professional and hospital accounts for Primary Care/Medical Specialty/Simple Procedural services from clinical documentation for accurate professional billing and facility APC assignment. The HIM Outpatient Surgery/Ambulatory Coder is a resource for the physicians and other health care providers in regard to coding and to review medical documentation to insure appropriate physician and facility coding and billing.

Responsibilities and Essential Job Functions

• Reviews outpatient/inpatient EHR for appropriate documentation and signatures, and reviews interface charges prior to billing.  Reviews departmental reporting structures and requests modifications as needed, i.e. adding billing areas, providers, etc.  Monitors CPT, ICD-10, and HCPCS code changes.  Audits and/or assigns professional and hospital codes and modifiers (CPT, HCPCS, and diagnosis) for Primary Care/Medical Specialty/Simple-Surgical accounts using ICD-10 nomenclature.  After completion of two years of coding may train on specialty/complex surgical coding.
• Reviews coding by physicians and suggest possible modification of codes to maximize reimbursement as allowed by coding and payer guidelines in accordance with supporting documentation.  Reviews reimbursement policy from payers to ensure payment through proper use of codes and modifiers.
• Identifies and resolves potentially troublesome service/billing areas such as continuity of care, discharge summaries, admission history and physicals and consultations.
• Resolves professional and hospital coding related edits and denied claims for outpatient surgical and ambulatory services.
• Communicates pertinent information on appropriate documentation to physicians and staff.
• Maintains knowledge of requirements for appropriate charge generation.
• Identifies and codes for all diagnoses documented supported within clinical documentation.  Captures unspecified diagnoses used and determine if documentation supports a more specific diagnosis
• Maintains a thorough understanding of anatomy and physiology, medical terminology, disease processes and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT coding guidelines to inpatient and outpatient diagnoses and procedures.
• Consults with and educates/trains physicians on coding practices and conventions in order to provide detailed coding information.
• Communicates with nursing and ancillary services personnel for needed documentation for accurate coding.
• Provides real-time feedback to providers as it pertains to proper coding and clinical documentation of services performed.
• Must be able to meet productivity requirements as outlined by clinical specialty and hospital quality requirements of 95% or better after training has concluded.
• Must be able to perform the professional, clinical and or technical competencies of the assigned unit or department.
• These statements are intended to describe the essential functions of the job and are not intended to be an exhaustive list of all responsibilities. Skills and duties may vary dependent upon your department or unit. Other duties may be assigned as required.

Required Education and Experience

• High School Graduate or GED.
• Coding accuracy: 95% or better in accordance with HIM Quality Analysis Policy.
• CPC or RHIT

Preferred Education and Experience

• Associates Degree in a related field of study from an accredited college or university.
• 1 or more years of experience in Epic.
• 1 or more years of experience in billing and/or data entry in a health care facility or physician office.
• Coding experience in inpatient and/or outpatient ICD-10 CM/PCS.

Required Language Skills

• Fluent English -

We are an equal employment opportunity employer without regard to a person’s race, color, religion, sex (including pregnancy, gender identity and sexual orientation), national origin, ancestry, age (40 or older), disability, veteran status or genetic information.