Outpatient Coding Specialist II (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.

A Brief Overview
Intermediate coding position that reviews clinical documentation and diagnostic results as appropriate to extract data and assign the appropriate International Classification of Diseases (ICD-10-CM/PCS) codes, CPT codes with modifiers, as well as grouping of Ambulatory Payent Classifications (APCs) for billing, internal and external reporting, research, and regulatory compliance. This position codes most (a minimum of three) types of outpatient records (for example, diagnostic, therapeutic, emergency department services, ambulatory surgery/same day surgery and observation service encounters) and follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of Ethical Coding as well as all American Hospital Association (AHA) Coding Clinics for HCPCS and the AMA CPT Assistant. Follows Stanford Health Care policies and procedures and maintains required quality and productivity standards. Reviews, abstracts and assigns technical and ethical ICD-10-CM/PCS and Current Procedural Terminology (CPT) codes with modifiers to outpatient services. Ensures compliance with third party, State and Federal regulations. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures and other services provided. Obtains missing information and/or clarifies existing information. Completes volume of work from work queues per departmental productivity standards. Groups codes and completed product. Analyzes information for optimal and proper reimbursement. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. Utilizes Epic, 3M Coding and Reimbursement System (Encoder), 3M CDIS, 3M Audit Expert, MS Office, and other software as appropriate to compile and validate medical information.
Responsible for validating and working any medical necessity edits that apply in the coding of the outpatient accounts, any error reports associated with revenue cycle process, for identifying and reporting error patterns, and, when necessary, assisting in design and implementation of workflow changes to reduce billing errors

Locations
Stanford Health Care

What you will do

• Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, CPT codes and modifiers as applicable, leading to the assignment of the correct Ambulatory Payment Classification (APC). The Outpatient Coding Specialist II is responsible for validating and working any medical necessity edits that are applicable in the coding of the outpatient account. Additionally responsible for verification of the patient’s discharge disposition and correct source of admission for state reporting purposes.
  
  If applicable to outpatient type responsible for coding, following established conventions and guidelines, codes and abstracts the medical records of day surgery and outpatient records. Assists with coding and leveling ERs as needed. Assists with coding and charging infusion cases as needed. Keeps work queues within established date goals.
  
  Codes procedures as appropriate and identifies the principal procedure consistent with established coding guidelines.
  
  Validates outpatient accounts for medical necessity based on local coverage determination policies (LCDs) or national coverage determinations (NCDs).
  
  Applies charge data as appropriate for services provided.
  
  Correctly abstract required data per facility specifications.
  
  Responsible for monitoring Discharged Not Billed accounts, and as a team, ensure timely, compliant processing of inpatient accounts through the revenue cycle.
  
  Collaborates with Clinical Documentation Specialists, (CDSs,) and members of the medical staff to ensure completeness of documentation in the medical records so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
  
  Responsible to ensure accuracy and maintain established quality and productivity standards.
  
  Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision. Exhibits strong time management, problem solving and communication skills.
  
  Critical thinking, good judgment and decision making skills
  
  Excellent written and oral communication skills
  
  Remain abreast of current Centers for Medicare and Medicaid Services, (CMS)