[Hiring] Outpatient Coder @Community Care Cooperative

Role Description

The Certified Outpatient Coder will be a part of an emerging coding team under the billing and credentialing service that performs coding review for FQHCs that are part of the billing service. The Outpatient Coder will report to the Director of Revenue Integrity and is responsible for reviewing ambulatory medical records for multi-specialty provider organizations to ensure billed codes are accurately supported by the clinical documentation. The coder will also be responsible for interpreting medical record data into language that the payers can interpret in order to process physician charges, and ensuring that coding is compliant with all coding guidelines.

Responsibilities

• Assigns appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other information.
• Ensures all coding is completed in a timely manner to meet billing deadlines.
• Assists in resolving incomplete and/or missing documentation in order to expedite billing.
• Communicates with healthcare providers to clarify coding questions and concerns.
• Performs Claim edit corrections and Denial reviews related to coding errors.
• Identifies coding or documentation trends that may pose a risk to revenue stream and reports such trends to management team.
• Stays abreast of coding and documentation guidelines, compliance policies, annual coding updates, payer policies and industry changes.
• All other duties as assigned.

Qualifications

• High School Diploma or equivalent required.
• CPC Certification required.
• 3-5 years CPT/HCPC Outpatient coding experience, preferably in a multi-specialty facility.
• Prior Epic experience highly preferred.

Requirements

• Knowledge of ICD-CM (current edition) CPT, HCPCS coding systems as well as CCI edits.
• Knowledge of third-party payer requirements, federal and state guidelines and regulations on medical coding and billing.
• Knowledge and understanding of current ICD-10-CM and CPT/HCPC Official Guidelines for Coding and Reporting.
• Knowledge of medical records content and management.
• Working knowledge of the EMR either through experience or education.
• Medical terminology.
• Knowledge of laws and regulations about health information and patient confidentiality.
• Proficient in Microsoft office applications such as Excel, Word and PowerPoint.
• Demonstrating flexibility with respect to changing end-user business needs.
• Good interpersonal and communications skills and demonstrates professionalism when working with team members, management and other staff members.
• The ability and willingness to take ownership of work activities and ensure that they are completed in an accurate, efficient, and timely manner.
• The ability and willingness to learn new software and systems.
• Ability to determine a problem’s cause and developing a course of action to resolve the problem and to prevent its recurrence.
• The ability to persevere in difficult situations and overcome obstacles.
• Must be able to remain in a stationary position 50-75% of the time.

Desired Other Skills

• Familiarity with the MassHealth ACO program.
• Familiarity with Federally Qualified Health Centers.
• Experience with anti-racism activities, and/or lived experience with racism is highly preferred.