Lead Certified Coder, Outpatient SDS-OBSV, Full Time, Day Shift-8Hr

Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.

Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.

Job Summary:

Reviews SDS and OBV records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Records types including same day surguery and observation encounter types. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work.

Job Requirements:

Education and Work Experience:

• High School Education/GED or equivalent: Preferred
• Associate’s/Technical Degree or equivalent combination of education/related experience: Preferred
• Working knowledge of hospital Cerner EMR (electronic medical record): Required
• Five years' SDS/OBV coding and health care experience: Required

Licenses/Certifications:

• AHIMA Certified Coding Specialist (CCS): Required

Essential Functions:

• Reviews APC and payor denials and provides feedback to leadership and other departments. Performs outpatient audits including payor audits and overall coding accuracy audits. Maintains denial and other spreadsheets for assigned denial and audit duties. Attends various meetings and provides coding feedback. Researches and provides feedback and direction to outpatient coding associates. Ensures coding corrections and edits are updated. Keeps abreast of regulatory changes related to coding and documentation and communicates these updates and changes to coding and leadership. Provides edicational sessions and training resources to coding associates. Understands and assists leadership and coding with reaching departmental metric goals. Abstracts and assigns ICD-10-CM diagnosis codes and CPT procedure codes from the SDS and OBV patient record to ensure accurate APC assignment and to provide information required for reimbursement and statistical data submissions.
• Validates appropriate dates of service against documentation in the EMR for SDS/OBV encounters. Completes required abstract fields in registration conversation on SDS/OBV encounter for OSHPD and other data submissions. Uses knowledge of modifier use to ensure accurate application on various payor types. Communicates with appropriate departments related to charge corrections/modifications. Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory agencies. Follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. Reviews, understands and applies quarterly coding clinics, coding guidelines and coding conventions of ICD-10-CM references. Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accurateness of documentation and physician coding practices. Analyzes content of reports and software edits to facilitate revisions with appropriate departments - NCCI edits.
• Follows up coding holds, revenue cycle department holds including related and all other email communication.
• Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accuracy of documentation and physician coding practices. Maintains required online Healthstream education courses.
• Attends meetings and training pertaining to coder education, audit reviews, staff meetings, outpatient coder roundtable meetings, and SDC to OBV charges.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations, including, but not limited to, measles, mumps, flu (based on the seasonal availability of the flu vaccine typically during October-March each year), COVID-19 vaccine (required in CA, HI and OR) etc., as a condition of employment, and annually thereafter. Medical and religious exemptions may apply.

Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities. Our com