Department 10347 Enterprise Revenue Cycle – Coding Production Operations: Outpatient Coding Operations
Status Full time
Benefits Eligible Yes
Hours Per Week 40
Desired Experience
Hospital‑Based / Facility Surgical Specialties Coding Experience, GI preferred.
Schedule
Monday – Friday 1st shift 40 hours a week.
Certification Required
Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).
Remote Opportunity
Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY.
Pay Range
$28.55 – $42.85
Major Responsibilities
Assuming all responsibilities of coding assistant, coder I and II plus the following: assist with special projects as requested, assist with training other coders as requested, monitor and respond to accounts in the charge router, charge router messages, CRMs, compliance and integrity review requests.
Adhere to organizational and internal department policies and procedures to ensure efficient work processes.
Review complex medical documentation from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes using ICD‑10 CM/PCS, CPT, and HCPCS, ensuring correct code selection following official coding guidelines and compliance with federal and insurance regulations.
Serve as subject matter expert in the assigned specialty and actively participate in coding meetings as a problem solver.
Apply expertise in query guidelines and coding standards; follow up to obtain clarification of inaccurate documentation as appropriate.
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and coding clinics; research coding‑related topics and issues.
Abide by the Standards of Ethical Coding set forth by the American Health Information Management Association and adhere to official coding guidelines; practice ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
Maintain confidentiality of patient records; report any perceived non‑compliant practices to the coding leader or compliance officer.
Meet and exceed departmental quality (95% or more) and productivity standards (100%). Achieve productivity expectations to support discharged not final billed (DNFB).
Perform any other assigned duties as necessary; duties listed are general in nature and may be changed at any time.
Assist in the production of annual edit review based on CPT, ICD and HCPCS changes and assist in developing edits based on publications and society updates.
Answer and prioritize correspondence at all levels (coding assistants, coders, leads, supervisors, managers).
Licensure, Registration, and/or Certification Required
Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).
Education Required
Advanced training beyond high school in Medical Coding or related field (or equivalent knowledge).
Experience Required
Typically requires 5 years of experience in professional coding that includes experience in professional revenue cycle processes and health information workflows.
Knowledge, Skills & Abilities Required
Proficient in Microsoft Office (Word, Excel, PowerPoint).
Advanced knowledge of anatomy, physiology, medical terminology, pathophysiology, the surgical terminology and pharmacology; able to apply these sciences to accurately assign codes to cases, including surgical cases.
Knowledge of National Council on Compensation Insurance, Inc (NCCI) edits and local/national coverage decisions.
Expert knowledge and experience in ICD‑10‑CM, CPT, and 3M Encoder.
Expert knowledge of ICD‑10‑CM and CPT coding systems, G‑codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Payment Classifications (APC).
Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
Expert knowledge of coding workflow and optimization of technology, including navigation in electronic health records and billing systems.
Excellent communication and reading comprehension skills.
Demonstrated analytical aptitude with a high attention to detail and accuracy.
Experience with remote workforce operations required.
Strong sense of ethics.
Physical Requirements and Working Conditions
Exposed to a normal office environment.
Must be able to sit for extended periods of time.
Must be able to continuously concentrate.
Position may require travel to other sites; may be exposed to road and weather hazards.
Operate all equipment necessary to perform the job.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. The incumbent may be required to perform other related duties.
Our Commitment to You – Benefits and Rewards
Paid Time Off programs.
Health and welfare benefits such as medical, dental, vision, life, and short‑ and long‑term disability.
Flexible Spending Accounts for eligible health care and dependent care expenses.
Family benefits such as adoption assistance and paid parental leave.
Defined contribution retirement plans with employer match and other financial wellness programs.
Educational Assistance Program.
Compensation Details
Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training.
Premium pay such as shift, on call, and more based on a teammate's job.
Incentive pay for select positions.
Opportunity for annual increases based on performance.
Responsible for the validation and/or abstraction coding of routine office to off‑premise patient visits, including surgeries, inpatient and outpatient procedures for all billable clinicians, ensuring that claims are submitted to insurance payers in the most compliant, efficient and expeditious manner possible. Serve as a point of contact for edit creation, coding and policy advice as well as review and create relevant documents for proposed changes for their assigned specialty. This position is accountable for accurate abstracting of selected clinical and non‑clinical information to create a comprehensive database of information for billing purposes, internal data management, and external reporting of data.
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