Coder I, Ancillary & Claim Edits (Remote)

Job Description:

Description:

The Coding Specialist I - Ancillary Coding & Claim Edits (Remote) is responsible for coding outpatient facility clinic and diagnostic healthcare records (lab, radiology, cardiology, bone density etc., and series which includes PT/OT/SP, infusion, radiation and wound care) by assigning the appropriate ICD-10-CM classification for valid diagnoses and validating CPT codes for procedures. This position also is responsible for Claim Edits and will review and respond to NCCI, OCE, LCD & NCD edits during the coding process.

The Remote Coder I - Ancillary Coding & Claim Edits is responsible for coding outpatient diagnostic (lab, radiology, cardiology, bone density etc., facility clinic and series which includes (PT/OT/SP, infusion, radiation, wound care) healthcare records by assigning the appropriate ICD-10-CM classification for valid diagnoses and validating CPT codes for procedures. This position also is responsible for Claim Edits and will review and respond to NCCI, OCE, LCD & NCD edits during the coding process. The coding information is used to determine APC’s (Ambulatory Payment Classification) for data quantitative analysis, quality research and claim submission. The Ancillary Remote Coding Specialist will use the EPIC and 3M software to identify appropriate codes and ensure the completeness of the coding record, investigate and track unbilled accounts, and work with appropriate resources to ensure timely filing/billing. Outpatient Surgery coding experience is helpful, but not required, as training can be provided based on experience. Infusion and Wound Care coding experience is preferred. 2 years coding experience preferred.

Essential Functions and Responsibilities

• Reviews the Electronic Health Record to determine Principal diagnoses, Secondary diagnoses and significant procedures to assign appropriate ICD & CPT codes for data retrieval, research and reimbursement purposes.
• Uses 3M electronic encoder and electronic code book to determine appropriate coding guidelines.
• Abstract outpatient data into EPIC abstract for research projects, quality improvement studies, and statistical reporting.
• Utilizes 3M Audit Expert, NCCI & OCE edits, LCD’s & NCD’s to determine appropriateness and completeness of coding and health record documentation.
• Codes accounts on a timely basis by payor’s cut-off dates under the “Just-in-Time” philosophy.
• Investigates and tracks unbilled accounts in EPIC to determine reason for incomplete status and works with appropriate resources for completion.
• Collaborates with Medical Staff and Clinical Documentation Specialists to ensure that documentation in health record supports services provided-to accurately and compliantly assign codes.
• Collaborates with members of various ancillary departments to complete special projects, also may serve on both intradepartmental and interdepartmental committees and task forces.

MINIMUM QUALIFICATIONS

Completion of an AHIMA-approved coding program or an AAPC-approved coding program, or Associate’s degree in Health Information Technology or a related field or an equivalent combination of years of education and experience is required. Bachelor’s degree in Health Information Management (HIM) or related healthcare field is preferred.

One (1) year of current acute care Outpatient coding experience is required.

Current experience utilizing encoding/grouping software or CAC is preferred. Epic EMR experience is preferred.

Ability to use a standard desktop/laptop, email and other Windows applications, if needed, Internet and web-based training tools preferred. 

Strong oral and written communication skills. Ability to communicate effectively with individuals and groups representing diverse perspectives.

Ability to work with minimal supervision and exercise independent judgment.

Ability to research, analyze and assimilate information from various sources based on technical and experience-based knowledge.  Must exhibit critical thinking skills, strong problem- solving skills and the ability to prioritize workload.

Excellent organizational and customer service skills. Ability to perform frequent detailed tasks and provide productivity standard driven results. Ability to adapt to change and be flexible with work priorities and interruptions. 

Must be comfortable functioning in a 100% virtual, collaborative, shared leadership environment. with minimal supervision and able to exercise independent judgement.

Must possess a personal presence that is characterized by a sense of honesty, integrity, and caring with the ability to inspire and motivate others to promote the philosophy, mission, vision, goals, and values of Trinity Health.

Hourly Pay Range: $21.10 - $31.65

The above statements are intended to describe the general nature and level of work being performed by persons assigned to this classification.  They are not to be construed as an exhaustive list of duties so assigned.