Job Description
The OUTPATIENT CODER I reflects the mission, vision, and values of NM, adheres to the organization's Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards.
An Outpatient Coder I is a coding and reimbursement expert in ICD-10-CM diagnosis coding with a focus on outpatient encounters for endoscopy lab, interventional radiology, heart catheterization lab, and outpatient clinic types.
RESPONSIBILITIES:
- Follows ICD-10-CM Official Guidelines for Coding and Reporting, Coding Clinics, interprets ICD-10-CM coding conventions and instructional notes to select appropriate diagnoses. Coding diagnosis from valid paper/electronic orders and provider reports.
- Should have expertise with HCPC Level I, II, CPT codes and national standard modifiers.
- Utilizes technical coding expertise to assign appropriate ICD-10-CM and/or CPT-4 codes to outpatient visit types when patient is seen by a provider.
- Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures
- Critical thinking demonstrated by correctly identifying issues and following processes when unable to complete coding on an account. (ADT edits, physician query for clarification of documentation, and missing documentation)
- Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
- Follows Coding Clinic for HCPCs, CPT Assistant, and interprets coding conventions and instructional notes to select appropriate diagnoses and procedures with a minimum of 95% accuracy
- Focus of anatomy on GI, cardiac catheterization lab, interventional radiology, outpatient diagnostics and procedures, physician order/requisition documentation
- Resolves specific Chargemaster NCCI or other outpatient edit claim failures as assigned
- Utilizes 3M Encoder resources to ensure optimal coding accuracy
- Articulates rationale for coding selections when necessary, i.e. prompted by results of data quality audit
- Meets established minimum coding productivity (90%) and quality standards (95%) for each outpatient encounter type