Assigns diagnosis and procedure codes for outpatient surgical or specialty encounters in the hospital or physician office setting. Abstracts required data elements for billing, reimbursement and state reporting. Queries providers regarding incomplete or inconsistent documentation. Resolves claim edits or claim denials related to coding. Ensures all collected data is accurate, complete and compliant with state and federal regulations as well as Official Guidelines for Coding and Reporting.
Accurately assigns ICD-10 diagnosis and CPT procedure codes for outpatient specialty services in the hospital or office setting. Abstracts data elements based on defined standards and regulatory requirements. Recognizes incomplete or missing documentation necessary to support code assignment and escalates appropriately to ensure timely resolution. Ensures assigned codes reflect the highest degree of specificity supported by the provider documentation. Demonstrates an understanding of standard coding and billing edits, as well as local and national coverage determinations. Supports timely resolution of billing edits and claim denials based on functional expertise. Appropriately communicates problems or issues related to timely completion of claims. Completes coding related duties as assigned to ensure smooth functioning of Coding Operations and compliance with Service Level Agreements. Meets or exceeds all established productivity and quality standards. Maintains credentials and memberships required for position.
Knowledge of medical terminology, disease processes, patient health record content and the medical record coding process. Knowledge of computer-based encoder systems and accurate data entry skills. Basic knowledge of anatomy, physiology and pharmacology. Familiarity with billing functions and the components of a charge description master. General knowledge of Revenue Cycle applications, including Electronic Health Record systems. Familiarity with Coding functions in acute and non-acute settings. Knowledge of Patient Management information system applications. Ability to communicate ideas both verbally and in writing to interact with others using on-on-one contact and group discussions. Ability to use spreadsheet, word processing, statistical, project management, and presentation software applications, preferably Microsoft Suite.
Days
Full Time
8
Friday, Monday, Thursday, Tuesday, Wednesday
None
Yes
No
Non-Exempt
40
Regular
Sutter Health is an equal opportunity employer EOE/M/F/Disability/Veterans.
Pay Range is $47.58 to $66.60 / hour
The compensation range may vary based on the geographic location where the position is filled. Total compensation considers multiple factors, including, but not limited to a candidate's experience, education, skills, licensure, certifications, departmental equity, training, and organizational needs. Base pay is only one component of Sutter Health's comprehensive total rewards program.