Coding Specialist - Outpatient Telecommute
Brown University Health, Green Corners, NY, United States
Summary
Reports to the Coding Manager. Reviews outpatient clinical documentation, extracts data, and assigns 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 medical records to ensure documentation supports the code assignment. Utilizes 3M 360 Finder for code assignment and appropriate resolutions of claim edits (CCI, NCD, OCE, etc.). Confers with physician for clarification as needed. Monitors outpatient uncoded reports to ensure timely coding and billing process. Maintains and meets HIS quality and productivity standards. Brown University Health employees are expected to role model the organization\'s values of Compassion, Accountability, Respect, and Excellence. In addition to values, employees demonstrate core Success Factors: Instill Trust and Value Differences, Patient and Community Focus, and Collaborate.
Responsibilities
Enter coded/abstracted information into 3M 360 Finder, assigning accurate APCs and reviewing all coding edits appearing in 3M.
Understand and follow all National Correct Code Initiative (NCCI) Edits and pertinent medical necessity requirements.
Resolve accounts on the claims edit database. Assign injections and infusion codes for observation patients.
Meet minimum productivity standards while maintaining an average accuracy rating of 95%.
Assign E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits, ensuring medical record documentation supports the code.
If physicians have entered diagnoses, ICD, or CPT codes, ensure they are accurate and documented in the medical record.
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 under 18 years.
Monitor and resolve rejected accounts on the Claims Edit Report and eClinicalWorks error reports within established timeframes, researching coding conflicts (including chargemaster, medical necessity, and other 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 with inappropriate charges.
Update patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follow procedures for rebilling accounts.
Perform related clerical duties as required. Maintain knowledge and expertise pertinent to the position.
Minimum Qualifications
Basic Knowledge:
High school diploma or equivalent. Successful completion of a 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).
Experience:
One to two years of experience in outpatient coding or billing. Ability to meet and maintain established quality and productivity standards.
Working Conditions Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, and use step-stools to file records. Ability to work under stressful conditions to maintain accounts receivable days while 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 is required.
Supervisory Responsibility None
Pay Range Pay Range:
$23.81-$39.28
EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
Location Location:
Corporate Headquarters - 15 LaSalle Square, Providence, Rhode Island 02903
Work Type Work Type:
Variable
Work Shift Work Shift:
Variable
Daily Hours Daily Hours:
8 hours
Driving Required Driving Required:
No
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Responsibilities
Enter coded/abstracted information into 3M 360 Finder, assigning accurate APCs and reviewing all coding edits appearing in 3M.
Understand and follow all National Correct Code Initiative (NCCI) Edits and pertinent medical necessity requirements.
Resolve accounts on the claims edit database. Assign injections and infusion codes for observation patients.
Meet minimum productivity standards while maintaining an average accuracy rating of 95%.
Assign E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits, ensuring medical record documentation supports the code.
If physicians have entered diagnoses, ICD, or CPT codes, ensure they are accurate and documented in the medical record.
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 under 18 years.
Monitor and resolve rejected accounts on the Claims Edit Report and eClinicalWorks error reports within established timeframes, researching coding conflicts (including chargemaster, medical necessity, and other 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 with inappropriate charges.
Update patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follow procedures for rebilling accounts.
Perform related clerical duties as required. Maintain knowledge and expertise pertinent to the position.
Minimum Qualifications
Basic Knowledge:
High school diploma or equivalent. Successful completion of a 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).
Experience:
One to two years of experience in outpatient coding or billing. Ability to meet and maintain established quality and productivity standards.
Working Conditions Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, and use step-stools to file records. Ability to work under stressful conditions to maintain accounts receivable days while 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 is required.
Supervisory Responsibility None
Pay Range Pay Range:
$23.81-$39.28
EEO Statement Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
Location Location:
Corporate Headquarters - 15 LaSalle Square, Providence, Rhode Island 02903
Work Type Work Type:
Variable
Work Shift Work Shift:
Variable
Daily Hours Daily Hours:
8 hours
Driving Required Driving Required:
No
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