Outpatient Coder

Job Summary

Reviews medical record documentation and diagnostic results to assign appropriate ICD-10-CM/PCS and HCPCS codes for billing, internal and external reporting, and compliance with the Official Coding Guidelines for Coding and Reporting, payer regulations, and hospital policy. Responsible for coding and abstracting outpatient medical records, to include but not limited to, simple ambulatory surgery, endoscopic, emergency center, clinic, and diagnostic medical records.

Queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices. Abides by the Standards of Ethical Coding as set forth by AHIMA.

Associate Degree in Health Information Management or related medical degree or High School Diploma or GED and 4 years directly related (Required)

• 1 or more years experience with ICD-9, ICD-10, and HCPCS coding preferably in a hospital setting. (Required)
• 1 or more years experience calculating APC and other payer reimbursement methodologies. (Preferred)
• 1 or more years experience requiring broad knowledge of medical terminology, pathophysiology, and pharmacology. (Required)

• Certified Coding Specialist (CCS) (Required)
• Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) (Required)

• Codes and abstracts outpatient medical records, to include but not limited to, simple ambulatory surgery, endoscopic, emergency center, clinic, and diagnostic medical records.
• Codes and appropriately sequences ICD-10-CM/PCS and HCPCS codes to assign primary diagnosis, co-morbidities and complications, secondary conditions, and surgical or designated non-surgical procedures to ensure appropriate reimbursement and statistical capture of data.
• Adheres to UHDDS guidelines, technical coding principals, and all applicable coding or payer guidelines for selection of codes and assignment of APCs.
• Verifies and abstracts all required medical data from the record to complete the abstract and ensure compliant billing practices, including but not limited to modifiers, discharge disposition, patient status, surgeon, surgery date, etc.
• Queries physicians to resolve incomplete or conflicting information to ensure compliant coding and billing practices
• Addresses all edits and warnings prior to final coding, and reviews and resolves all accounts returned for medical necessity or other coding and billing discrepancies.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.

• Adheres to the hospital and departmental attendance and punctuality guidelines.
• Performs all job responsibilities in alignment with the core values, mission and vision of the organization.
• Performs other duties as required and completes all job functions as per departmental policies and procedures.
• Maintains current knowledge in present areas of responsibility (i.e., self education, attends ongoing educational programs).
• Attends staff meetings and completes mandatory in-services and requirements and competency evaluations on time.
• Demonstrates competency at all levels in providing care to all patients based on age, sex, weight, and demonstrated needs.
• For non-clinical areas, has attended training and demonstrates usage of age- specific customer service skills.
• Wears protective clothing and equipment as appropriate.