Medical Coding Specialist - Outpatient (Full time 1.0 FTE; Remote - Wisconsin)

Job Description:

Reviews medical reports and physician documentation for clinic and hospital outpatient services in order to apply diagnostic and procedural codes to individual patient health information for claims processing, data retrieval and analysis.

• Assigns codes for ambulatory outpatient services using International Classification of Diseases (ICD) and Current Procedural Terminology (CPT) coding protocols, for facility and professional services. Includes professional code entry for Emergency Room and Urgent Care providers.
• Audits the electronic medical record for accuracy of patient information, insurance information, appropriate diagnosis, and procedure codes to ensure accurate documentation for billing and reimbursement.
• Reviews and resolves National Correct Coding Initiatives (NCCI) and Outpatient Code Editor (OCE) edits.
• Communicates with clinical department directors and medical billing staff to clarify coding guidelines and resolve claim edits.
• Identifies and communicates missed revenue opportunities to ambulatory departments. Works with business analyst to create new charge codes, as needed.
• As assigned, investigates denied claims from insurance carriers and appeals timely to ensure accurate reimbursement.
• Abstracts pertinent information from patient records using hospital information system.
• Queries physicians as needed to provide clarification on documentation or code assignment.
• Identifies coding concerns or trends. As needed, involves Revenue Cycle leadership to assist with resolution.
• Provides education on coding changes.
• Attends continuing education programs and reviews other educational resources to keep current on any changes pertaining to this position and for coding re-certification.
• Assists with developing policies and procedures related to coding.
• Assists in training new employees and job shadowing.
• Performs other related work assignments as required.

Education:

• Required: Successful completion of a professional American Health Information Management (AHIMA) or American Academy of Professional Coders (AAPC) recognized coding course and/or an Associate degree in a healthcare related program.
• Preferred: Associates degree in a healthcare related program.

Experience:

• Required: 1 year outpatient professional coding; Experience with insurance denials and inquiries.
• Preferred: Outpatient Plastic Survey experience preferred.

Licenses and Registrations:

• Required: None.
• Preferred: None.

Certification(s):

• Required: Must obtain credentials through the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) in any of the following certifications within six months of date of hire and maintain such credential thereafter:

• Registered Health Information Technician (RHIT) or Administrator (RHIA).
• Certified Coding Associate (CCA).