Employment Type:

Shift:

Description:

POSITION PURPOSE

Analyzes physician/provider documentation contained in Outpatient health records to perform acute Outpatient coding of diagnostic encounters such as laboratory, radiology, Simple Visit Coding (SVC) failed encounters and series accounts.

Utilizes encoder software applications, which includes all applicable online tools and references in the assignment of Internal Classification of Diseases, Clinical Modification diagnosis and procedure codes, and Current Procedural Terminology / Healthcare Common Procedure Coding System (HCPCS) procedure codes and all required modifiers.

Utilizes coding guidelines established by:

• The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting
• The American Hospital Association (AHA) Coding Clinic
• The American Medical Association (AMA) for CPT codes and CPT Assistant
• The American Health Information Management Association (AHIMA) Standards of Ethical Coding
• Revenue Excellence/Health Ministry (HM) coding procedures and guidelines

ESSENTIAL FUNCTIONS

Knows, understands, incorporates, and demonstrates the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions.  

Navigates the patient health record and other computer systems/sources in determination of diagnoses, procedures and modifiers to be coded.

Codes Outpatient encounters utilizing encoder software and online tools and references, in the assignment of ICD, CPT, and HCPCS codes and modifiers.

Maintains current knowledge of Medical Necessity review guidelines for commercial, Medicare and Medicaid insurance products, including but not limited to Local Coverage Determination, National Coverage Determination and CCI Edits. 

Communicates effectively with clinical staff, physicians and office staff regarding  documentation issues or needs.   

Works with HIM and Patient Business Services (PBS) teams, when needed, to help resolve billing, claims, denials and appeals issues affecting reimbursement.

Exhibits awareness of health record documentation or other coding ethics concerns. Notifies appropriate leadership for assistance, resolution when appropriate.

Utilizes EMR communication tools to track missing documentation that requires follow-up to facilitate coding in a timely fashion.

Maintains current knowledge of changes in Outpatient coding and reimbursement guidelines and regulations eg new modifiers.  

 Adheres to coding quality and productivity standards established by Revenue Excellence/HM.

Maintains CEUs as appropriate for coding credentials as required by credentialing associations.

Performs other duties as assigned by leadership.

Maintains a working knowledge of applicable Federal, State and local laws/regulations; the Trinity Health Integrity and Compliance Program and Code of Conduct; as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

MINIMUM QUALIFICATIONS

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate’s degree in Health Information Technology or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred. 

Certified Coding Associate (CCA), Certified Procedural Coder Apprentice (CPCA), Certified Procedural Coder (CPC), Certified Outpatient Coder (COC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA) or Certified Coding Specialist (CCS) is required.

One (1) year of current acute care Outpatient coding experience is required.

Current experience utilizing encoding/grouping software or CAC is preferred.  Epic EMR experience is preferred.

Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred.  

Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various sources based on technical and experience-based knowledge.  Must exhibit critical thinking skills, strong problem- solving skills and the ability