Hospital Based Outpatient Coder Ii - Miramar, United States - Memorial Healthcare System

Memorial Healthcare System

Verified Company

Miramar, United States

3 weeks ago

Posted by:

Mark Lane

beBee recruiter

Description

At Memorial, we are dedicated to improving the health, well-being and, most of all, quality of life for the people entrusted to our care.

An unwavering commitment to our service vision is what makes the difference. It is the foundation of The Memorial Experience.

Summary:

Reviews medical record documentation to assign ICD-10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.

Responsibilities:

For hospital encounters, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing.

Reviews chargemaster generated CPT/HCPCS codes, when errors are found Coding Management is notified to alert Charge Management to educate department making errors.

Makes appropriate coding corrections when advised and follows procedure to notify billing. For Professional Billing, routes to billing charge entry errors and/ or account edits preventing completion of coding and/or billing.

Enhances and maintains coding knowledge and skills for physician billing. Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.

Communicates with insurance companies about coding errors and disputes for physician billing. Reviews and validates accuracy of data in Admission-Discharge-Transfer (ADT) fields following HIM coding policies and procedures. Reviews CRW (Certified Social Worker) documentation to assign correct discharge disposition, notify coding management when clarification needed.

Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.

Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding. Meets and maintains HIM coding quality and productivity standards. Submits daily productivity report to HIM manager by defined deadline.

Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits. Reviews Local Coverage Determination (LCD) edits and guidance for codes meeting medical necessity. Research electronic medical record for any additional diagnoses documented to meet medical necessity.

Codes various OP service lines for all MHS specialties that include encounters with high complexity of surgical procedures and assign anesthesia procedure codes (hospital) following specific payer requirements.

Reads and interprets all provider documentation which includes all dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to admission.

Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding. Create electronic physicians queries within allowed scope for hospital outpatient coder.

Reviews all appropriate work queues daily to address edits and make corrections following Health Information Management (HIM) coding policies and procedures.

Conducts, audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing.

Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.

Competencies:

ACCOUNTABILITY, ACCURACY - CODER, ACCURACY - OUTPATIENT, ANALYSIS AND DECISION MAKING, CUSTOMER SERVICE, EFFECTIVE COMMUNICATION, HEALTH INFORMATION MANAGEMENT (HIM) SYSTEMS - CODER, HEALTH INFORMATION MNGMT, MEDICAL RECORD CODING, MEDICAL TERMINOLOGY (1), PRODUCTIVITY - OP CODING, RESPONDING TO CHANGE, STANDARDS OF BEHAVIOR

Education and Certification Requirements:

High School Diploma or Equivalent (required)Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA)

Additional Job Information:

Working Conditions and Physical Requirements: