Outpatient Coder II

Exemption Status:

Non-Exempt

Hiring Range:

$0.00 - $0.00

Please note that the final offer may vary within this range based on a candidate's experience, skills, qualifications, and internal equity considerations
.

Schedule Details:

Monday through Friday

Scheduled

Hours:

7a-3:30p

Shift:

1 - Day Shift, 8 Hours (United States of America)

Hours:

40

Cost Center:

99940 - 5470 ED Coding and Revenue Capture

This position may have a signing bonus available a member of the Recruitment Team will confirm eligibility during the interview process.

Everyone Is a Caregiver

At UMass Memorial Health, everyone is a caregiver - regardless of their title or responsibilities. Exceptional patient care, academic excellence and leading-edge research make UMass Memorial the premier health system of Central Massachusetts, and a place where we can help you build the career you deserve. We are more than 20,000 employees, working together as one health system in a relentless pursuit of healing for our patients, community and each other.

And everyone, in their own unique way, plays an important part, every day.

Interprets a wide variety of clinical and diagnostic documentation in order to process hospital and / or pro-fee charges for episodes of outpatient care. Assigns appropriate ICD-CM (current edition) and CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as appropriate adhering to official coding guidelines.

• 1. Upon review of the medical record, performs analysis on documentation, which includes review of tests / reports to determine the appropriate ICD-CM (current edition) and / or CPT codes as well as modifiers. Based on account type, may assign ICD-PCS codes, as defined by official coding guidelines and other recognized reference materials.
• 2. Verifies documentation is present to substantiate codes assigned.
• 3. Assists in resolving incomplete and / or missing chart documentation in order to expedite coding and billing.
• 4. Participates in the continuous coding audit and performance management program.
• 5. Maintains coding accuracy rate of not less than 95% for optimal reimbursement as well as department productivity standards as outlined in department policies.
• 6. Attends required training classes and coding in-services each year to stay abreast of new regulations and coding guidelines.
• 7. Participates in improvement efforts and documentation training for medical and clinical staff as it relates to coding practices and guidelines.
• 8. Communicates to Manager when backlog situations arise or necessary documents are either incorrect or are not being received in a timely manner.
• 9. Refers all unusual, questionable situations to the direct Manager.
• 10. Alerts management to any coding irregularities, or trends contrary to policies / procedures, so corrective measures may be taken.
• 11. Adheres to the coding and billing regulations established by the American Hospital Association (AHA), American Medical Association (AMA), and Centers for Medicare and Medicaid Services (CMS).
• 12. Maintains direct and ongoing communications with other coding personnel to maximize overall effectiveness and efficiency of the operation.
• 13. Keeps current with all coding updates and information related to correct coding.

• 1. Complies with established departmental policies, procedures and objectives.
• 2. Attends variety of meetings, conferences, seminars as required or directed.
• 3. Demonstrates use of Quality Improvement in daily operations.
• 4. Complies with all health and safety regulations and requirements.
• 5. Respects diverse views and approaches, demonstrates Standards of Respect, and contributes to creating and maintaining an environment of professionalism, tolerance, civility and acceptance toward all employees, patients and visitors.
• 6. Maintains, regular, reliable, and predictable attendance.
• 7. Performs other similar and related duties as required or directed.

All responsibilities are essential job functions.

• 1. High School diploma or equivalent

• 1. Medical coding certification
• 2. Training in medical terminology from an accredited program, completing and passing certification program within one year from date of hire. (Recognized programs include:
  American Health Information Management Association (AHIMA) and American Academy of Professional Coders (AAPC).
• 3. Certification as a Certified Coding Specialist (CCS) or Certified Coding Specialist - Physician (CCS-P)

• 1. Knowledge of ICD-CM (current edition) and CPT coding systems as well as CCI edits
• 2. Knowledge of third-party payer requirements as well as federal and state guidelines and regulations pertaining to coding and billing practices.
• 3. Good interpersonal and communications skills and demonstrates professionalism
• 4. Good customer service skills with the ability to communicate efficiently.
• 5. Good organizational skills with attention to detail.
• 6.…