Outpatient Hospital Reimbursement & Coding Specialist III, Remote

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Erlanger Health hires employees for telecommuting/remote positions in the following states:

AL, AZ, GA, FL, IN, KY, LA, MD, MI, MS, MO, NC, NV, OH, SC, TN, TX, VA, WI, WY

REMOTE



Job Summary :

Utilizing an electronic medical record and computerized encoder, assigns and sequences diagnosis and procedure codes and present on admission indicators (inpatient only) on inpatient or outpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures.

Inpatient Coding

• Must code all types of adult and pediatric Inpatient cases including long length of stays, mortality, trauma, L&D, NICU, and normal newborns.

• Must code all types of outpatient cases includes, ED, outpatient, OBS, Same Day Surgery.

• Reviews inpatient or outpatient medical records to assign and sequence all appropriate diagnosis and procedures codes utilizing encoder software and following by proficiently translating diagnostic statements, procedure descriptions, physician orders, and other pertinent documentation. Reviews Medicare Severity Diagnosis Related Groups (MSDRGs) and All Patient Refined Diagnosis Related Groups (APRDRGs) on inpatient cases or Ambulatory Payment Classification (APCs) on outpatient cases for appropriate code assignment.
• Reviews and validates accuracy of Admission-Discharge-Transfer (ADT) data fields; abstracts admission type, point of origin, discharge disposition, physicians, procedure dates and on inpatient cases present on admission (POA) indicators.
• Reviews appropriate coding work queues daily to address coding edits and needed corrections and follows procedure to notify billing as needed. Reviews accounts and performs needed correction for internal audits and external denials.
• When documentation or valid order is incomplete, vague, or ambiguous, it is the responsibility of coder to work in conjunction with Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable diagnosis, procedure and/or physician order.
• Outpatient coders are responsible for following charge verification processes and routing accounts based on missing, incomplete, or inaccurate charging.

• Adherence to Health Information Management (HIM) Coding policies.
• Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures. OP coding validates reason for visit and IP validates admit diagnosis.
• Adherence to Det Norske Veritas (DNV) and other third-party documentation guidelines in an effort to continually improve coding quality and accuracy.
• Responsibility for maintaining coding certification and knowledge referencing diagnosis and procedural coding classification system coding guidelines and regulatory changes.
• Contacts the appropriate department or physician for assistance in obtaining physician clarification of Diagnoses and procedures.
• Participates in performance improvement initiatives as assigned.

• Knowledge of Anatomy and Physiology, Disease Pathology, and Medical Terminology.
• Knowledge of coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding.
• Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers.
• Accurate translation of written procedure descriptions to accurately assign ICD 10 PCS procedure codes for inpatient and CPT/HCPCs codes for outpatient accounts.
• Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of…