Hospital Outpatient Coder II - HIM MSS - Remote Eligible

Location

Miramar, Florida

Reviews medical record documentation to assign ICD‑10 CM codes to complex diagnoses and CPT codes and modifiers to procedures for outpatient encounters to ensure proper coding, billing, and compliance.

• For hospital encounters, routes billing charge entry errors and/or account edits preventing completion of coding and/or billing. Makes appropriate coding corrections when advised and follows procedure to notify billing.
• Reviews charge master generated CPT/HCPCS codes when errors are found. Coding Management is notified to alert Charge Management to educate department making errors.
• For Professional Billing, routes to billing charge entry errors and/or account edits preventing completion of coding and/or billing.
• Enhances and maintains coding knowledge and skills for physician billing. Maintains strict adherence to patient confidentiality according to MHS standards and regulatory requirements.
• Communicates with insurance companies about coding errors and disputes for physician billing.
• Reviews and validates accuracy of data in Admission‑Discharge‑Transfer (ADT) fields following HIM coding policies and procedures.
• Reviews CRW documentation to assign correct discharge disposition and notifies coding management when clarification is needed.
• Attends internal and external educational meetings and seminars to maintain certification and continuing education requirements.
• Adjusts and adapts to continual changes in the coding field. Practices ethical coding per AHIMA Standards of Ethical Coding.
• Meets and maintains HIM coding quality and productivity standards. Submits daily productivity report to HIM manager by defined deadline.
• Reviews encounters to assign and sequence appropriate diagnoses (including HCC Coding Hierarchical Condition Category) and CPT procedure codes as well as modifiers to complex diagnostic and surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using encoder, reviews Ambulatory Payment Classifications (APC) and Enhanced Ambulatory Patient Groups (EAPG) assignments. Reviews coding edits, LCD edits and guidance for codes meeting medical necessity.
• Researches electronic medical record for any additional diagnoses documented to meet medical necessity.
• Codes various OP service lines for all MHS specialties, including high‑complexity surgical procedures and assigns anesthesia procedure codes (hospital) following specific payer requirements.
• Reads and interprets all provider documentation, which includes dictated, scanned, and electronically created documents, imaging, pathology reports, and labs pertaining to admission.
• Reviews all appropriate work queues daily to address edits and make corrections following HIM coding policies and procedures.
• Conducts audits and/or coding reviews with various health care professionals to ensure all documentation is accurate for physician billing.
• Seeks clarification from healthcare providers or other designated resources to ensure accurate and complete coding.
• Creates electronic physicians' queries within allowed scope for hospital outpatient coder.

Accountability, Accuracy - Coder, Accuracy - Outpatient, Analysis and Decision Making, Customer Service, Effective Communication, HMS Systems - Coder, HMS Management, Medical Record Coding, Medical Terminology (1), Productivity – OP Coding, Responding to Change, Standards of Behavior.

High School Diploma or Equivalent (Required).

Certifications:

Certified Coding Specialist (CCS) – AHIMA, Registered Health Information Administrator (RHIA) – AHIMA, Registered Health Information Technician (RHIT) – State of Florida (FL), Registered Health Information Technician (RHIT AHIMA) – AHIMA.

Complexity of Work:
Requires critical thinking skills, effective communication skills, decisive judgment, and the ability to work independently with minimal supervision. Must be able to work in a stressful environment and take appropriate action. Proficient in basic computer skills including…