Out Patient Coding Analyst

A Brief Overview

Responsible for research, management and resolution of pre-bill edits, and pre-bill errors. Conducts and or facilitates any other activities related to regulatory related coding requirements reviews, denials, surgery reservation CPT/PCS code(s) assignment and patient inquiries requiring coding review.

• Reviews claims edits, from different source systems, via assigned work queues, leveraging coding and regulatory expertise, enabling cases to be successfully processed in a timely and accurate manner.
• Prepares material through research of coding and/or payer guidelines for claims denials. Reviews coding and recommends updated coding changes and/or provides appeal documents to follow up Team.
• Responsible for reviewing assigned surgery reservation forms and assigning appropriate CPT/PCS and ICD10 codes to initiate pre certification process.
• Reviews requests from the Customer Service department related to HIS coding disputes.
• Performs analytic reviews of encounters generated by vendors or other external sources.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. Maintains credentials. Maintains updated knowledge of regulatory guidelines and regulations affecting the coding field. Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Trending for potential edits and working with the Coding Educator to develop training and ongoing education based on identified needs.

• Participates in educational and informational activities.
• Participates in student mentorship programs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education

• Associate's Degree in HIM (Required)
• Bachelor's Degree In HIM (Preferred)

Work Experience

• 4 years ICD-10 coding experience, preferably in a large academic medical center. (Required)
• 3 years with hospital revenue accounting, billing, reimbursement and/or patient accounting (Required)
• Experience in working directly with physicians and others (Preferred)

Knowledge, Skills, & Abilities

• Expertise in surgical/procedure coding. (Required proficiency)
• Thorough, up-to-date clinical skills, current working knowledge of pathology, pharmacology, surgical procedures, etc. (Required proficiency)
• Excellent written and verbal communication skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Detail-oriented and organized, with good problem solving ability. (Required proficiency)
• Notable client service, communication, and relationship building skills. (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). Proven ability to work within multiple systems. (Required proficiency)

Licenses and Certifications

• Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) (Required)
• Certified Coding Specialist (CCS) (Preferred)

Physical Demands

• Standing Occasionally
• Walking Occasionally
• Sitting Constantly
• Lifting Rarely 20 lbs
• Carrying Rarely 20 lbs
• Pushing Rarely 20 lbs
• Pulling Rarely 20 lbs
• Climbing Rarely 20 lbs
• Balancing Rarely
• Stooping Rarely
• Kneeling Rarely
• Crouching Rarely
• Crawling Rarely
• Reaching Rarely
• Handling Occasionally
• Grasping Occasionally
• Feeling Rarely
• Talking Constantly
• Hearing Constantly
• Repetitive Motions Frequently
• Eye/Hand/Foot Coordination Frequently