Ancillary Outpatient Coding Specialist
Purpose: Codes ancillary outpatient accounts, diagnosis coding only. Codes ancillary service patient type (single visit service such as lab, x-ray, pathology specimen); requires ICD-9 diagnosis coding skills only. Coder reviews the physician script, order or chief complaint as documented in a diagnostic report to determine the appropriate ICD-9 code. Ensures diagnosis codes meet local medical necessity guidelines for ancillary tests that were ordered-- requires knowledge of billing and coding guidelines. Respond to Cirius errors identified by coder ID on the daily report.
Responsibilities:
- Refer problem accounts to appropriate coding or management personnel for resolution.
- Meet appropriate coding productivity and quality standards within the time frame established by management staff.
- Adhere to internal department policies and procedures to ensure efficient work processes.
- Actively participate in monthly coding meetings and share ideas and suggestions for operational improvements.
- Maintain continuing education by attending seminars, reviewing updated CPT assistant guidelines and updated coding clinics.
- Review coding for accuracy and completeness prior to submission to billing system utilizing CCI edits.
- Utilize standard coding guidelines and principles and coding clinics to assign the appropriate ICD-9-CM/ICD-10-CM, CPT and DSM IV codes for outpatient records to ensure accurate reimbursement.
- Determine diagnoses that were treated, monitored and evaluated and procedures done during the episode of care are sequenced in order of their clinical significance to accurately assign the appropriate APC/ASC or payment tier under the Prospective Payment system or DSM IV methodology to guarantee accurate reimbursement on UPMC patients.
- Utilize computer applications and resources essential to completing the coding process efficiently, such as hospital information systems, EHR information systems, encoders and electronic medical record repositories.
- If applicable, abstract required medical and demographic information from the medical record and enter the data into the appropriate information system to ensure accuracy of the database.
- Complete work assignments in a timely manner and understand the workflow of the department including routing cases appropriately in the electronic systems.
- Code by assigning and verifying the principle and secondary diagnoses (ICD-9-CM/ICD-10-CM) and procedures (CPT codes or DSM, IV if applicable) by thoroughly reviewing all documentation available at the time of coding.
- Complete a non coding time productivity sheet as required/applicable.
High School or GED equivalent. Completed an AHIMA or AACP-certified Coding program or certificate, Bidwell Training School or equivalent program. Curriculum includes Anatomy and Physiology, Medical Terminology, ICD-9-CM/ICD 10 and CPT Coding Guidelines and Procedures. 6 months hospitals coding experience preferred.
Licensure, Certifications, and Clearances:
- Act 34
- UPMC is an Equal Opportunity Employer/Disability/Veteran