Coder, Medical Billing and Coding, Healthcare Administration

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Under the direction of the Health Information Management Director, the Outpatient Coder I accurately determines ICD-10-CM diagnosis codes and ICD-10-CM, CPT and HCPCS procedure codes for outpatient medical records that may include Emergency Department (ED), outpatient laboratory, diagnostic imaging, minor outpatient procedures, infusion and injections, outpatient labor and delivery, recurring accounts and observation stays.

• Abstract pertinent information from patient records within various outpatient types. Assign ICD-10-CM / ICD-10-PCS codes or HCPCS codes, creating ambulatory payment classification (APC).
• Monitor and manage the discharged not final billed (DNFB) accounts within assigned patient types daily to meet financial goals and expectations.
• Meet coding productivity standards and accuracy rate determined by company policy. (See Coding Productivity and Quality Standards.)
• Query clinical staff to achieve accuracy in coding.
• Educate, train and communicate with medical staff regarding accurate documentation for the purposes of coding.
• Keep abreast of coding guidelines and reimbursement reporting requirements. Bring identified concerns to supervisor or department manager for resolution. Abide by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adhere to official coding guidelines.
• Abstract data and reports to the Virginia Trauma Registry.
• Participate in the appeals process for coding denials. Initiate and respond to requests for billing to support medical necessity, appropriateness of code assignment, and payer requirements to support the billing function.
• Answer telephone and respond to requests in a professional, timely manner.
• Maintain professional credentials through ongoing coding education and company requirements for annual continuing education.
• Contribute to quality improvement activities of the department and the organization, including participating in internal department and corporate audits.
• Participate in other department or organizational activities as requested.

• Effective oral and written communication skills.
• Demonstrated competence with personal computers, networks, and Microsoft Office.
• Experience with various abstracting and coding systems and electronic health record systems.
• Ability to work independently or as a team member to accomplish tasks or projects.
• Ability to prioritize work assignments during periods of stress.
• Ability to sit for long periods of time.
• Corrected visual acuity for long periods of reviewing/reading medical records and viewing a computer monitor.
• Knowledge and skills to correctly assign reason for visit/first listed diagnosis for outpatient encounters and correctly assign additional diagnoses based on coding rules and guidelines.
• Critical thinking, time management, and organizational skills.

Age Specific

Definition

Yes / No

Birth to One Year — Infant

2 – 3 Years — Toddler

4 - 5 Years — Pre-Schooler

6 – 11 years — School Age

12 - 17 years — Adolescent

18 – 30 years

31 – 64 years — Adult

65+ — Geriatric

No responsibility to treat or care for patients

Exposure to:

• None
• Some
• Frequent

Toxic/caustic chemicals

Moving mechanical parts

Dust/fumes/gases/helicopter

Blood or Body Fluids

Communicable Diseases

Potential electrical shock

X-ray electromagnetic energy

Needles or sharp objects

Frequent repetitive motions

Use/viewing of computer monitor

Unprotected heights

Physically or verbally abusive patients

Hazards in patients’ homes

Extreme heat or cold

• 50% of time spent traveling

Exposure to high pitched noises

PHYSICAL DEMANDS: (X) Sedentary Work:
Lifting 10 lbs. maximum and occasionally lifting and/or carrying articles. () Light Work:
Lifting 2 lbs. maximum with frequent lifting and/or carrying of objects weighing up to 10 lbs. ( ) Medium Work:
Lif…