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Under the general supervision of the Outpatient (OP) Coding Manager and OP Coding Supervisor, the OP Coder will review outpatient records and accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPC, and modifiers to ensure the correct APC assignment. The OP coder will work closely with the Coding leadership, and OP Coding Validators to ensure coding uniformity, consistency, and accuracy with ICD-10-CM, CPT, Official Coding Guidelines, Federal and State regulations, the American Hospital Association coding guidelines and its publication Coding Clinic. The OP coder is also responsible for meeting or exceeding quality and quantity expectations while performing coding functions to support timely coding and billing.

Job Description:

Essential Duties & Responsibilities including but not limited to:

Hospital Coding:

Review the complete electronic and scanned medical records of discharged patients. Assigns ICD-10-CM, CPT/HCPC, and Modifiers from documentation in the medical record.

· Abstracts coded data and patient information into the coding abstracting system in use by BILH (examples of information include attending physician, surgeon, dates of surgery, disposition, discharge date, and infant birth weight).

· Applies ICD-10-CM and CPT Official Guidelines for Coding and Reporting, AHA Coding Clinic Advice, and facility-specific guidelines when coding outpatient records.

· Sequences the assigned codes using 3M software, and exercises all principles of assigning and sequencing ICD-10-CM and CPT/HCPC codes for comprehensive coding and appropriate APC assignment.

· Participates in training programs, including educational sessions for ICD-10-CM and CPT/HCPC coding guidelines and updates.

· Follows hospital-specific guidelines to identify and facilitate prompt resolution of documentation, abstracting, and/or other account problems.

Professional Coding Coding Responsibilities:

· Provides review and/or coding of any professional services including but not limited to surgeries and diagnostic services for appropriate use of CPT, ICD-10 - CM, HCPCS, and Modifier usage/linkage as well as provide ICD-10- CM coding where needed for missing diagnoses.

· Productivity and accuracy standards must be met according to guidelines set by the manager.

· Prospective audit of charges entered by providers as well as provide feedback to providers

· Periodic review of codes, at least annually or as introduced or required for new, revised, or deleted code updates.

· Answers and responds accurately and timely to questions from providers and other departments

· Reviews and analyzes rejected claims and patient inquiries of professional services, and recommends appropriate coding when necessary

· Reports regularly on findings of reviews/rejections as required by the manager.

Physician/Provider Education:

· Confers regularly with physicians/other qualified health care providers, clinical or ancillary managers, coders, or other staff through departmental staff meetings, one-on-one meetings, and/or daily interactive communication to respond to and educate providers on specific departmental and clinic-wide coding issues and updates.

· Participates in new physician/care provider orientation as well as provides follow-up reviews and education for the new physician/care provider if applicable for the area of responsibility.

· Provides feedback, recommendations, and participates as the coding representative for the Professional Coding Department on the Revenue Cycle Teams as requested by the manager. · Develops and conducts a schedule of physician/care provider documentation reviews in areas where applicable and/or as defined by the manager.

· Provides feedback to the physician/other qualified health care provider, Department Chair, and/or Administration as required.

· Documentation review is ongoing and feedback will be provided to the physician/ other qualified health care provider, Department Chair, and/or Administration as required.

Minimum Qualifications:

Education:

Hospital Coding · Minimum of an Associate degree in Health Information Management or Completion of an AHIMA or AAPC Coding Certification program, required

OR

Professional Coding · High School Diploma or equivalent, plus additional specialized training associated with the attainment of a recognized Coding Certificate.

Licensure, Certification & Registration:

Hospital Coding · RHIA, RHIT, or CCS from AHIMA or a COC from AAPC, required

OR

Professional Coding · CPC (Certified Professional Coder through the American Academy of Professional Coders) or CCS-P (Certified Coding Specialist Physician based through the American Health Information Management Association)

Experience:

Hospital Coding

· Minimum 3 years of ICD-10-CM, CPT/HCPC Outpatient coding assignment, required

· Minimum 1 year of ICD-10-CM, CPT/HCPC outpatient coding assignment at a Level 1 trauma or Academic Medical Center, preferred

· Microsoft Office applications · Interventional Radiology, Cardiac Cath, Injection and Infusion, Observation, and Ambulatory Surgery coding experience, preferred

· Computer skills

OR

Professional Coding

· Minimum 5 years of Professional Coding experience in conjunction with the requirements indicated above

· Microsoft Office applications

· Interventional Radiology, Cardiac Cath, Injection and Infusion, Observation, and Ambulatory Surgery coding experience, preferred

· Computer skills

Required Skills, Knowledge & Abilities:

· Medical terminology

· Proficient in Microsoft Office Excel, Word, and PowerPoint applications

· Knowledge and understanding of current ICD-10-CM and CPT Official Guidelines for Coding and Reporting

· Knowledge of medical records content and management

· Working knowledge of the EMR either through experience or education, including experience working with structured data and database management

· Strong written communication skills

· Knowledge of laws and regulations about health information and patient confidentiality

· Adheres to Department, Hospital, and Human Resource Policies

Preferred Qualifications & Skills:

· Epic experience

· 3M-360 Computer Assisted Coding

Dept./Unit-Specific Skills:

· OP Coder II level ICD-10-CM, CPT Outpatient code assignment skills based on BILH OP Coder Exam

Key Business Relationships: (Title and Purpose)

1 Coding Director Day to day direction, scheduling and support

2 Medical Staff Provide support, education and training

3 Coding colleagues Process improvement, knowledge sharing, quality of work, productivity and training and education

4 External facilities Work with hospitals, provider practices and vendors on requests related to Coding and Validation

Physical Requirements & Environment:

· Secured remote location to work in compliance with HIPPA guidelines

· Internet access to support BILH system requirements

· Ability to sit for extended periods of time

Pay Range:

$29.80 - $47.68

The pay range listed for this position is the base hourly wage range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law.  Compensation may exceed the base hourly rate depending on shift differentials, call pay, premium pay, overtime pay, and other additional pay practices, as applicable to the position and in accordance with the law.

As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled