CODER II - OUTPATIENT (PROCEDURAL)

FLSA Status

Job Role Summary

This position exists to provide timely and accurate clinical coding and abstraction of outpatient services, to facilitate optimized reimbursement, research, and PI initiatives.  This position is responsible for, but not limited to, the coding, abstraction, and charge entry (as applicable) of one or more of the following:  ancillary/diagnostic services, ambulatory surgery, observation, interventional radiology, and emergency department.

Essential Functions and Responsibilities

•    Proactively contributes to Eskenazi Health mission:  Advocate, Care, Teach and Serve with special emphasis on the vulnerable population of Marion County.  Supports Eskenazi Health’s core values: to respect all people, to be culturally competent, to work with integrity, to provide superior quality healthcare and emphasize patient safety, to always learn and develop, and to be good stewards of our resources.
•    Coding and Abstracting:  Identifies and assigns the appropriate, diagnosis, procedure, and evaluation and management (E&M) codes in accordance with coding guidelines and departmental standards.  Maintains acceptable levels of performance related to productivity and quality standards.
•    Charge Entry:  Maintains a working Service Item Master (SIM) knowledge of defined departments.  Captures charges accurately based on documentation, and integrates charges and codes appropriately.  Makes suggestions for additions to the SIM upon recognition of new procedures and/or supplies.
•    Problem Solving:  Utilizes available resources appropriately to maintain quality and consistency in coding, abstraction, and charge entry processes.  Follows a defined process to query the medical staff for completion and/or clarification of documentation necessary to ensure coding compliance and accuracy.  
•    Medical Necessity:  Recognizes cases that require specific medical necessity coverage diagnoses, and applies Local Coverage Determination (LCD) policies as necessary. 
•    Software Applications:  Utilizes applicable software to retrieve documentation, abstract data/codes, and retrieve work lists.

Job Requirements

•    Requires a minimum of High School diploma and coding credential from AHIMA or AAPC 
•    Requires a minimum of 3 year coding experience ICD-10, CM, CPT-4 and HCPCS coding classification system.

Knowledge, Skills & Abilities

•    Requires knowledge of Local Coverage Determinations (LCDs), Correct Coding Initiative (CCI) edits, APC grouping methodology, and the healthcare billing process.
•    Requires general knowledge of medical terminology, anatomy and physiology, diagnostic and therapeutic tests, surgical procedures, and medical record documentation standards and retrieval.
•    Requires knowledge of E&M guidelines and assignment for emergency department coding positions.
•    Requires ability to apply medical necessity coverage determinations as applicable, and seek coverage in the medical record documentation. 
•    Requires general computer skills, and be able to learn new skills quickly.
•    Requires a high level of concentration, self-motivation, attention to detail, and persistent follow-up
•    Requires professional and courteous interactions
•    Requires ability to solve routine job-related issues, and sound judgment of when to request assistance from management
•    Requires the ability to set and adjust priorities