Outpatient Health Information Coding and Reimbursement Specialist

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Outpatient Health Information Coding and Reimbursement Specialist -

Purpose of Position :
Assigns diagnosis and procedural codes to hospital outpatient medical records to facilitate the reimbursement and data collection for the individual business units of Cape Cod Healthcare facilities.

• Assigns, analyzes, sequences and validates codes based on medical record documentation using the automated encoder, book and other coding compliance and reimbursement resources as needed.
• Demonstrates complete understanding of Official Coding Guidelines, CCI edits, anatomy, physiology, and medical terminology to appropriately code complex outpatient encounters; including but not limited to clinics such as oncology/infusion clinics, outpatient surgery, observation encounters including infusion and injection procedures.
• Reviews all medical record documentation to determine and assign diagnoses, procedures, level codes and modifiers, to ensure appropriate coding for hospital reimbursement.
• Reviews the appropriate documentation to enter/update charges as necessary in order to apply the correct procedure code(s), date of service, appropriate modifiers.
• Ensures that coding compliance, regulatory and reimbursement requirements are met.
• Abstracts pertinent information into the coding abstracting system and hospital billing system as needed.
• Assess adequacy of documentation and queries physicians and other healthcare providers to obtain additional medical record documentation or to clarify documentation to ensure accurate and appropriate coding and hospital reimbursement.
• Reconciles medical records to be coded within work queues to maintain or exceed established fiscal departmental goals, and in accordance with departmental procedures.
• Maintains a 95% ongoing accuracy rate based on Medical Record Department performance monitors, third party validation audits and internal/external coding audits.
• Consistently achieves weekly coding output within the minimal productivity standards set by HIS management. Self-manages and prioritizes work flow to achieve timely submission of claims and optimal coding productivity standards.
• Maintains accurate productivity logs and provides this information to the Coding Manager in a timely fashion.
• Assists in the orientation and development of new coding personnel.
• Assumes professional responsibility for development of skills and ongoing education to maintain active coding certification.
• Remains abreast of developments in health information management by pursuing a program of professional development, attending educational programs and meetings and reviewing pertinent literature.
• Continuously monitors medical record documentation, coding and patient financial computer systems, individual performance and department workflow…