Title: Hospital Outpatient Coder

Department: Revenue Cycle

Reports To: Coding Manager

Status: Full-Time

Position Summary:

The Hospital Outpatient Coder will be primarily responsible for hospital OP coding including ER (and associated professional fees), surgical, lab, radiology and infusion. They will ensure the timely and accurate coding of medical claims. Furthermore, they will ensure maximum reimbursement for services provided by utilizing sound knowledge of coding rules and regulations, best practice workflows, and the use of multiple software systems.

NOTE: A Coding Competency Assessment Test will be provided for qualified applicants prior to their first interview

Qualifications:
Education and/or Experience:

• High School Diploma is required, Associates is preferred.
• Two to five years medical coding experience is required.

Licenses/Certifications Required:

• Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.

General Requirements/Job Duties:

Employee must have the skills, ability and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Specific job duties will vary based upon client assignment. Employee will also abide by ruralMED’s policies as a condition of employment.

Charge Entry

• Receive and review charge entry data from practice sites.
• Identify and investigate incomplete or missing charges.

Coding:

• Abstracts clinical information; translates medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems.
• Sequences codes according to established guidelines.
• Thoroughly analyzes and interprets medical information, medical diagnoses, coding/classification systems, to ensure accuracy for prospective payment system reimbursement.
• Conducts training for physicians/staff on coding and or documentation practices.

Other:

• Maintains current knowledge of coding rules and regulations as designated by the AMA, Centers of Medicare and Medicaid Services (CMS) and other payers.
• Maintains proficient knowledge of EHR, as well as any other systems, required for performing required job duties.
• Communicates issues to management, including payer, system, or escalated account issues. Identifies medical necessity denial trends and provide suggestions for resolution.
• May perform other billing functions including claim submission, unpaid claims follow-up, denial resolution.
• Participates in department meetings, in-service programs, and continuing education programs.
• Maintains a professional attitude with patients, visitors, physicians, office staff and hospital personnel. Assures confidentiality of patient information, maintaining compliance with policies and procedures.
• Performs other duties as assigned.

Required Knowledge, Skills and Abilities:

• Knowledge of medical terminology is required.
• Proficient with Microsoft Office

Patient Age Groups Served:

None.

Essential Work Environment & Physical Requirements:

The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.