Coding Specialist - Outpatient Telecommute

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SUMMARY:

Reports to the Coding Manager. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD‑10‑CM and CPT codes in accordance with the outpatient ICD‑10‑CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics. Reviews the medical records to ensure the documentation supports the code assignment. Utilizes 3M 360 Finder for code assignment and appropriate resolutions of claim edits (CCI, NCD, OCE, etc.)

Confer with physician for clarification as needed. Monitors outpatient uncoded report to ensure timely coding and billing process. Maintains and meets HIS quality and productivity standards. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.

The core Success Factors include:
Instill Trust and Value Differences Patient and Community Focus and Collaborate.

• Enter codedbstracted information into 3M 360 Finder assigning accurate APC and reviewing all coding edits appearing in 3M.
• Understand and follow all National Correct Code Initiative Edits (NCCI) and follow pertinent medical necessity requirements.
• Resolve accounts on the claims edit database.
• Assign injection and infusion codes for observation patients.
• Meet the minimum productivity standard maintaining an average accuracy rating of 95%.
• Assign E/M, ICD‑10‑CM, CPT or charge master codes to clinic visits ensuring medical record documentation supports the code.
• Ensure diagnosis, ICD or CPT codes entered by physicians are accurate and supported by documentation.
• Utilize 3M to identify and resolve NCCI edits before final billing.
• Report documentation insufficiencies to the responsible physician.
• Follow Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients less than 18 years of age.
• Monitor and resolve rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including charge master, medical necessity and other coding and billing issues.
• Refer complex coding issues to the coding validator or supervisor.
• Review pertinent outpatient uncoded reports researching and resolving old uncoded accounts and any accounts posted on report for inappropriate charges.
• Update patient financial accounts in the Patient Management and Patient Accounting billing system as required.
• Follow established procedures for rebilling accounts.
• Perform related clerical duties as required.
• Maintain level of knowledge and expertise pertinent to the position.

• High school diploma or equivalent.
• Successful completion of formal coding educational program.
• Ability to read and understand outpatient clinic medical record documentation for reporting of outpatient clinic, ancillary and endoscopies.
• Coding certification required from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).
• One to two years experience in outpatient coding or billing.
• Ability to meet and maintain established quality and productivity standards.

Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, use step‑stools to file records. Ability to work under stressful conditions to maintain accounts receivable days achieving productivity and accuracy.

Independent Action:
Performs independently within the department’s policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

Supervisory Responsibility:
None.

$23.81 - $39.28 per hour.

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903.

Work Type:
Variable

Work Shift:

Variable

Daily

Hours:

8 hours

Driving

Required:

No

Entry level.

Full‑time.

Health Care Provider.

Hospitals and Health Care.