Outpatient Coding Specialist

This is a fully remote position, open to applicants in Ohio.

📋 Description

• This advanced outpatient coding role involves reviewing medical record documentation and accurately assigning ICD-10-CM, ICD-10-PCS, and CPT IV codes according to the specific record type, while abstracting essential data elements for each case in accordance with federal regulations.

• The position entails coding all varieties of outpatient visits, including ancillary services, urgent care, emergency department visits, observation, same-day surgery, and interventional procedures.

• Adheres to the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Coding Ethics, as well as the American Hospital Association (AHA) Coding Clinics, CMS directives, and Bulletins, along with communications from Fiscal Intermediaries.

• Utilizes coding applications in line with established workflow processes.

• Follows Mercy Policies and Procedures while maintaining the required quality and productivity standards.

• Reviews medical record documentation and accurately assigns the appropriate ICD-9-CM, ICD-10, CPT IV, and HCPCS codes using 3M software tools for all outpatient work types (Ancillary, ED Charge/Code, Same-Day Surgery, and Observation).

• The assigned codes must support the documented reason for the visit and the medical necessity as provided by the healthcare provider to justify the care delivered.

• When applicable, applies necessary charges such as Evaluation & Management (E&M) levels, injections, infusions, and other requirements for Observation cases via third-party software systems like LYNX.

• Correctly abstracts required data according to facility specifications.

• Conducts "medical necessity checks" for Medicare and other payers as mandated by payment guidelines.

• Responsible for monitoring and addressing accounts that are Discharged Not Final Billed, resolving failed claims, stop bills, and premises as a team, ensuring timely and compliant processing of outpatient claims within the billing system.

• Maintains established productivity requirements and key performance indicators for 3M 360 CAC for CRS & Direct Code while ensuring accuracy to uphold established quality standards.

• Stays informed about current requirements from the Centers for Medicare & Medicaid Services (CMS), including National Coverage Determinations (NCD) and Local Coverage Determinations (LCD) guidelines related to modifier assignment, to ensure the submission of clean claims on the first attempt.

• Maintains competency and accuracy while employing tools of the trade, such as the 3M encoder, Computer-Assisted Coding (CAC), Medical Necessity software, abstracting systems, code books, and all relevant reference materials.

• Reports any inaccuracies discovered in Coding Software to HIM Management/Supervisor and flags any potential unethical or fraudulent activities according to compliance policy.

• Adheres to all established Mercy Health policies and procedures, including compliance with paid time off (PTO) requirements.

• Attends mandatory system, hospital, and departmental meetings as well as educational sessions established by leadership, and completes required annual learning programs to ensure ongoing education and growth.

• Engages in Training/Mentoring - SMART Responsibilities where applicable.

⛳️ Requirements

• Required Minimum Education: Vocational/Technical Degree in Health Information Management (HIM) or Coding Certification.

• Preferred Education: 2-year Associate's Degree in Health Information Management (HIM) or Coding Certification.

• Required: If RHIA, RHIT, or CCA is obtained upon hire without COC or CCS, the candidate must acquire COC or CCS and CRCR within one year of hire.

• Preferred: RHIA, RHIT, CCS, COC, CCA, or CPC certification.

• Minimum Years and Type of Experience: Completion of a Coding Curriculum with at least one year of prior coding experience.

• Other Knowledge, Skills, and Abilities Required: Successful completion of Medical Terminology and Anatomy and Physiology courses.

• Completion of ICD-10 training.

• Previous experience with Coding Software Tools.

• Understanding of medical record content, including electronic medical records (EMRs).

• Ability to work independently with minimal supervision as well as collaboratively within a team.

• Capability to function under continuous deadlines.

• Aptitude for maintaining accuracy despite frequent interruptions.

• Proficiency in keyboarding skills and a working knowledge of computer systems.

🏝️ Benefits

• Competitive pay, incentives, referral bonuses, and a 403(b) plan with employer contributions (when eligible).

• Comprehensive medical, dental, vision, and prescription coverage, along with HSA/FSA options, life insurance, mental health resources, and discounts.

• Paid time off, parental and FMLA leave, short- and long-term disability, and backup care for children and elders.

• Tuition assistance, support for professional development, and continuing education opportunities.