|
Inspire health. Serve with compassion. Be the difference. Job Summary Responsible for leading coding teams, coder training, work queue management, performing prebill and second-level coding reviews utilizing auditing tools and applicable software. Uses knowledge of coding and compliance guidelines to identify potential documentation, coding and reimbursement issues and report these to coding leadership. Employs critical thinking skills to alert coding leadership to any trends identified in their reviews and to make suggestions for continual process improvement. Maintains knowledge of CPT and HCC documentation requirements to ensure correct code assignment. Performs outpatient coding by assigning ICD-CM, CPT codes and appropriate modifiers. Reviews and responds to outpatient level denials as needed. Performs Outpatient coding by assigning ICD, CPT codes and appropriate modifiers as well as attention to HCC capture.
Essential Functions
All team members are expected to be knowledgeable and compliant with Prisma Health's values: Inspire health. Serve with compassion. Be the difference. Conducts review of outpatient records to include, GI, outpatient surgery, emergency department records, observation, diagnostic, Interventional Radiology and other identified records to validate the code assignment according to official coding guidelines as supported by the clinical documentation in the record. Monitors and maintains work queues daily to identify, prioritize and assign accounts that need to be coded based on department-specific guidelines and within designated timelines coordinating with leadership. Mentors and trains coders on application of correct ICD-CD and CPT guidelines. Assists with and develops educational programs for coding staff, clinical documentation staff and medical staff to including yearly coding/CPT updates. Codes outpatient records periodically based on review of clinical documentation. Identifies physician query opportunities following established guidelines when existing documentation is unclear or ambiguous following American Health Information (AHIMA) guidelines and established policy. Identifies and assists management with the resolution of coding issues, process improvement and system testing for Health Information Management (HIM) applications. Participates in on site, remote and/or external training workshops and training. Maintains working knowledge of Centers for Medicare & Medicaid Services (CMS) regulations and applicable carrier local medical review policies. Collaborates with Coding leadership to develop and maintain coding curriculum and training handbook. Interacts and assists with other departments to resolve coding issues. Performs other duties as assigned.
Supervisory/Management Responsibilities
Minimum Requirements
Education - Certification Program or Associate degree or Coding Certificate through approved American Health Information Management (AHIMA), American Academy of Professional Coders (AAPC) or other coding certification program. Experience - Four (4) years of experience in outpatient coding and abstracting with healthcare billing process experience in acute care setting. Experience with charge capture, billing and edits preferred.
In Lieu Of
Required Certifications, Registrations, Licenses
Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Coding Specialist (CCS), Certified Professional Coder (CPC, CPC-H) or other approved coding credential.
Knowledge, Skills and Abilities
Knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process. Ability to apply broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability. Knowledge of electronic medical records and 3M or Encoder System. EPIC health information system experience preferred. Knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process. Ability to work effectively, independently and manage multiple demands consistently. Proficient computer skills (spreadsheets, database).
Work Shift Day (United States of America)
Location Corporate
Facility 7001 Corporate
Department 70017512 HIM Coding
Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
|
Prisma Health
Jul 03, 2025