Mercy Health Outpatient Coder - Remote in Youngstown, Ohio
Outpatient Coder - Remote
Job ID: 4660490
Updated: March 14, 2018
Location: Youngstown, OH, United States
Full/Part Time: Full-Time
Standard Hours: 40
Advanced outpatient coding position that reviews medical record documentation and accurately assign ICD-10-CM, ICD-10-PCS, as well as CPT IV codes based on the specific record type and abstract specific data elements for each case in compliance with federal regulations. This position codes all types of outpatient visits to include ancillary, urgent care, emergency department, observation, same day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association, (AHIMA,) Coding Ethics, as well as the American Hospital Association, (AHA) Coding Clinics, CMS directives and Bulletins, Fiscal Intermediary communications. Utilizing Coding Applications in accordance with established workflow. . Follows Mercy Policies and Procedures and maintains required quality and productivity standards.
- Reviews medical record documentation and accurately assigns appropriate ICD-9, ICD-10, CPT IV, and HCPCS codes utilizing the 3M software tools. The assigned codes must support the reason for the visit and the medical necessity that is documented by the provider to support the care provided. When applicable, apply the appropriate charges such as the Evaluation & Management, (E&M,) level and injections and infusions, and/or other necessary requirements based on financial class, using a third party software system such as LYNX.
- Correctly abstract required data per facility specifications.
- Perform "medical necessity checks" for Medicare and other payers as required per payment guidelines.
- Responsible for monitoring Discharged Not Final Billed Claims, and as a team, ensure timely, compliant, processing of outpatient claims in the billing process.
- Responsible to maintain established productivity requirements, key performance indicators established for 3M 360 CAC for CRS & Direct Code as well as ensure accuracy to maintain established quality standards.
- Remain abreast of current requirements of the Centers for Medicare & Medicaid Services, (CMS,) to include National Coverage Determinations, (NCD) and Local Coverage Determinations, (LCD) guidelines, related to the assignmente of modifiers, to ensure the submission of a clean claim the first time through.
- Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, Computerized Assisted Coding, (CAC,) Medical Necessity software, abstracting system, code books, and all reference materials. Reports inaccuracies found in Coding Software to HIM Management/Supervisor, reports any potential unethical and/or fraudulent activity per compliance policy.
- Follows all established Mercy Health policies and procedures to include abiding by paid time off, (PTO) requirements.
- Attends required system, hospital and departmental meetings and educational sessions as estabilished by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.
- Training/Mentoring - SMART Responsibilities where applicable.
- Other duties as assigned.
Qualifications - Minimum
- Vocational/Technical Degree in HIM/ Coding required
- 2 year/Associates Degree preferred
- If RHIA or RHIT or CCA upon hire without COC or CCS, will be required to acquire COC or CCS and CRCR within 1 year of hire
- Completion of Coding Curriculum wtih on year of previous coding experience required
- Satisfactory completion of Medical Terminology and Anatomy and Physiology. Knowledge of medical record content, to include electronic medical records, (EMRs.) Ability to function independently, with minimal supervision, as well as part of a team. Ability to function under continual deadlines. Ability to maintain accuracy during frequent interruptions. Proficiency in keyboarding skills and working knowledge of computers. Excellent communication skills.
- Previous coding experience in an acute care setting and previous use of coding software tools. Previous use of CAC preferred.
Shift and Job Schedule
Full-time at 40 hours/per week on first-shift, with a weekend rotation.
This is a fully remote position.
Equal Employment Opportunity
It is our policy to abide by all Federal and State laws, as well as, the requirements of 41 CFR 60-1.4(a), 60-300.5(a) and 60-741.5(a), prohibiting discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities, and prohibiting discrimination against all individuals based on their race, color, religion, sex, sexual orientation, gender identity, or national origin.
This position will be a part of the revenue cycle team at Ensemble Health Partners - a wholly owned subsidiary of Mercy Health. Ensemble Health Partners specializes in providing revenue cycle solutions and creating real value for its clients by building relationships, reducing revenue cycle spend and delivering exceptional results. Ensemble partners with hospitals across the United States to make real and lasting improvements that impact the bottom line.