Outpatient Certified Coder

Job Summary

Job Summary: The role of a Certified Outpatient Coder at Care New England is to ensure accurate assignment of ICD-10 CM, CPT and HCPCS codes on a wide range of patient medical records for outpatient services. Outpatient services include, but are not limited to observation, surgical, provider-based visits, interventional radiology, emergency room, oncology, and other specialty services. A proficient understanding and execution of coding guidelines to ensure accuracy of coding and maintain records in accordance with accepted medical and legal standards.

Adherence and compliance to various regulatory guidelines from CMS, AHA and AMA.

• Analyze medical records, extracting clinical, pathological, therapeutic and epidemiologic data in accordance with established ICD-10-CM coding principles and guidelines
• Assigns Codes and codes all diagnostic and operative information from the medical record using ICD-10-CM/ICD-10-CM, ICD-10 PCS, CPT, HCPCS coding classification systems and independently quality checks own work
• Ensures that all data abstracted is consistent with guidelines outlined by JCAHO, and CMS, regional and local policy
• Evaluating, addressing and understanding CCI, LCD and NCD edits
• Ensure data is optimally coded for documentation capture, financial reimbursement, care planning, statistics and regulatory reporting
• Reviews medical records to determine accurate required abstracting elements (facility/client specific elements) including appropriate discharge disposition to ensure accurate reimbursement
• Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems
• Demonstrates knowledge of anatomy, physiology pharmacology and pathophysiology to interpret general medical classifications for coding discharge data.
• Ensures timely record availability by meeting established coding and abstracting CNE productivity and accuracy standards
• Communicates and resolves coding issues around documentation for appropriate follow-up and education
• Interacts and communicates with department lead and manager to clarify and accurately document patient diagnostic and procedural information
• Maintains and complies with policies and procedures for confidentiality of all patient records
• Performs other related duties as assigned

• Must have at least three (3) years hospital experience within the last five years.
• This position has a preferred certification as a Certified Coding Specialist (CCS).
• A Certified Professional Coding certification will also be considered with additional years of experience.
• Completion of classes in medical terminology, anatomy and physiology, ICD-10 and CPT coding conventions, and disease process from an accredited program.
• Coding certification must be maintained on an annual basis.