Coder - Outpatient - FT

Job Description

WOOSTER COMMUNITY HOSPITAL JOB DESCRIPTION

Coder - Outpatient

MAIN FUNCTION:

The Outpatient Coder is responsible to review, abstract, assign appropriate ICD10-CM, CPT codes as needed to certain outpatient patient charts/accounts. The outpatient coder provides front end order validation for walk in and scheduled outpatient services. Assists the revenue cycle team by performing audits to detect, assess and resolve re-imbursement and revenue compliance concerns. Involved in the charge capture process.

RESPONSIBLE TO: System Director of Revenue Cycle

MUST HAVE REQUIREMENTS:

Previous coding experience / knowledge.

Ability to follow written and verbal directions.

Knowledge of state and federal coding regulations.

Knowledge of Anatomy, Physiology, Disease Processes, and Medical Terminology.

Holds a CPC certification or CPC eligible (has completed the necessary education to sit for the CPC exam)

If not credentialed at time of hire, then applicant must become credentialed within 6 months of hire to remain employed.

Ability to operate computer on a daily basis and perform basic office procedures.

No written disciplinary action within the last 12 months.

PREFERRED ATTRIBUTES:

Prior hospital outpatient or physician office coding experience.

* Denotes ADA Essential

* Follows Appropriate Service Standards

POSITION EXPECTATIONS:

* Reviews outpatient orders for walk in and scheduled outpatient services to verify order validity, completeness and medical necessity. Follows up on incomplete or invalid orders with ordering physician to secure an appropriate order, or advise registration/clinical staff of the need to notify the patient of non-coverage due to medical necessity not being met.

* Receives and responds to incoming phone calls from clinical departments for ICD10 coding assignment questions for medical necessity

* Utilizes encoder software to apply codes and finalize bill.

* Assigns ICD10/CPT/HCPC codes as needed on assigned outpatient accounts, and maintains assigned worklists according to productivity standards.

* Able to prioritize most needed coding and code in a timely manner.

* Abstracts demographic information as needed. Completes Trauma Registry logs as needed.

* Works with Manager with problem accounts. Tracks down these accounts and works with the physician to complete these records and codes them for billing.

* Reports any problems in coding, billing or registrations to the Manager.

* Ensures that chart information supports the diagnosis and treatment. Charts must be thoroughly reviewed and discrepancies communicated to the physician for correction or further documentation.

* Performs audits of revenue cycle processes utilizing reports from various software applications (i.e. Craneware, Meditech, Quadex, etc.) and report findings to the Manager.

* Must be able to perform audits utilizing all source documents, including the medical record, itemized charges, UB04 and charging worksheets.

4/95 Revised Dates: 3/00, 6/00, 3/02, 9/03, 1/04, 3/05, 5/09, 11/10, 10/15, 2/16, 8/19

Approved by Human Resources:

Full-time