Outpatient Coder - SS Revenue Cycle - Toledo Market

Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications.  Utilizing Coding Applications in accordance with established workflow.  . Follows Mercy Policies and Procedures and maintains required quality and productivity standards.

ESSENTIAL FUNCTIONS

• Reviews medical record documentation and accurately assigns appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools for all OP Work Types (Ancillary, ED Charge/Code, Same Day Surgery, and Obseration.  . The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M) level and injections and infusions, and/or other necessary requirements for Observation cases, using a thrid party software systems such as LYNX.

• Correctly abstract required data per facility specifications.

• Perform "medical necessity checks" for Medicare and other payers as required per payment quidelines.

• Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills,and epremis as a team, ensure timely, compliant processing of outpatient claims in the billing system.

• Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.

• Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignmente of modifiers, to ensure the submission of a clean claim the first time through.

• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials.  Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy

• Follows all established Mercy Health policies and procedures to include abiding by paid time off, (PTO) requirements.

• Attends required system, hospital and departmental meetings and educational sessions as estabilished by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.

• Training/Mentoring - SMART Responsibilities where applicable

Required Minimum Education: 

Vocational/Technical Degree, Specialty/Major:HIM / Coding Certification

Preferred Education: 2 year/Associate's Degree, Specialty/Major:HIM / Coding Certification

LICENSURE/CERTIFICATIONS (must be non-expired/active unless otherwise stated):

Required: If RHIA or RHIT or CCA upon hire without COC or CCS, will be required to acquire COC or CCS and CRCR within 1 year of hire 

Preferred: RHIA or RHIT or CCS or COC or CCA or CPC

MINIMUM QUALIFICATIONS

Minimum Years and Type of Experience: Completion of Coding Curriculum with one year of previous coding experience.

Other Knowledge, Skills and Abilities Required: Satisfactory completion of Medical Terminology and Anatomy and Physiology. Completion of ICD-10 training.  Previous use of Coding Software Tools.  Knowledge of medical record content to include electronic medical records, (EMRs.) Ability to function independently, with minimal supervision, as well as part of a team. Ability to function under continual deadlines. Ability to maintain accuracy during frequent interruptions. Proficiency in keyboarding skills and working knowledge of computers. Excellent communication skills.

Other Knowledge, Skills and Abilities Preferred: Previous coding experience in an acute care setting and previous use of coding software tools.  Previous use of CAC.