Outpatient Medical Coder
HealthCare Resolution Services, Inc. (HCRS) Fairfield, CA
- Posted: over a month ago
Responsible for assignment of accurate Evaluation and Management (E&M) codes, ICD diagnoses, current procedural terminology (CPT) and Healthcare Common Procedure Coding System (HCPCS), modifiers and quantities derived from medical record documentation (paper or electronic) for outpatient encounters. Trains and educates MTF staff on coding issues and plays a significant role in coding compliance activities.
- Responsible for assignment of accurate E&M, ICD, CPT and HCPCS codes and modifiers from medical record documentation.
- Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external.
- Interacts with MTF staff to ensure documentation is clear and supports coding assignments.
- Educates MTF staff through individual or group in-services and training sessions.
- Maintains a delinquency report of missing records in order to facilitate completion of work within the required thresholds.
Competencies /Mandatory Knowledge and Skills
- Position requires excellent computer/communication skills for provider and staff interactions
- Knowledge of anatomy/physiology and disease process, medical terminology, coding guidelines (outpatient), documentation requirements, familiarity with medications and reimbursement guidelines; and encoder experience.
- Candidate must have ability to handle multiple projects and appropriately prioritize tasks to meet deadlines.
Education/ Experience and Certification. MSS personnel in this position require ONE of the following to fulfill minimum educational requirements:
Registered Health Information Technologist (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder (CPC) CCS-P (Certified Coder Specialist Physician (CCS-P) with the appropriate level of experience.
A minimum of three year experience in the outpatient setting (physicians office or ambulatory surgery centers) within the last five years, including assignment of E&M, CPT, and HCPCS codes. Multiple specialties encompass different medical specialties (i.e. Family Practice, Pediatrics, Gastroenterology, OB/GYN, etc.) that utilize ICD, E&M, CPT, and HCPCS codes. Ancillary specialties (PT/OT, Radiology, Lab, Nutrition, etc.) that usually do NOT use E&M codes do not count as qualifying experience. Additionally, coding, auditing and training exclusively for specialties such as home health, skilled nursing facilities, and rehabilitation care will not be considered as qualifying experience. Coding experience limited to making codes conform to specific payer requirements for the business office (insurance billing, accounts receivable) is not a qualifying factor. Two years of coding experience may be qualifying if received in a military medical facility.
Coding Test. Pass a pre-employment coding test approved by the AFMS MCPO that includes questions and/or multiple choice scenarios on the following topics: Medical Terminology, Anatomy and Physiology; Outpatient, Emergency Department (ED), Observation, and Inpatient Evaluation and Management (E&M) coding and professional component of procedures; Ambulatory Surgery professional component of procedures; and Outpatient, ED, Observation. Ambulatory Surgery and Inpatient facility
component of procedures. Passing score for the coding is a minimum of 70%, with the candidates score to be reported in the qualification documents by the contractor management staff.
Competencies, Knowledge, and Skills:
- Practical knowledge of the International Classification of Diseases, Clinical Modification (ICD-CM), and Procedural Coding System (PCS); Healthcare Common Procedure Coding System (HCPCS); and
- Current Procedural Terminology (CPT);Practical knowledge of reimbursement systems, including, but not limited to, Prospective Payment System (PPS) and Diagnostic Related Groupings (DRGs); Ambulatory Payment Classifications (APCs); and Resource-Based Relative Value Scale(RBRVS);
- Practical knowledge and understanding of industry nomenclature; medical and procedural terminology; anatomy and physiology; pharmacology; and disease processes.
- Practical knowledge of medical specialties; medical diagnostic and therapeutic procedures; ancillary services (includes, but is not limited to, Laboratory, Occupational Therapy, Physical Therapy, and Radiology); and revenue cycle management.
- Computer skills; proficient in using multiple software programs to review documentation and enter codes and other information.
- Excellent communication and interpersonal skills for interactions with providers, clinical staff, and other MHS staff.
- Make well-informed, effective, and timely decisions, even when data are limited or solutions produce unpleasant consequences; perceives the impact and implications of decisions.
- Clearly express information (for example, ideas or facts) to individuals or groups effectively, taking into account the audience and nature of the information.
- Utilize medical computer software programs to abstract, analyze, and/or evaluate clinical documentation and enter/edit diagnosis and procedure codes.
- Write in a clear, concise, organized, and convincing manner for the intended audience; use correct English grammar, punctuation, and spelling; communicate information (for example, facts, ideas, or messages) in a succinct and organized manner; produce written information, which may include technical material, that is appropriate for the intended audience.
- Display, courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.
- Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
- Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
- Understand and interpret written material, including technical material, rules, regulations, instructions, reports, charts, graphs, or tables; applies what is learned from written material to specific situations.
- Attention to detail and completeness with a thorough understanding of government rules and regulations, medical coding and reimbursements.
- Medical, Dental and Vision through Carefirst BCBS
- 401K plan with employer match
- Paid Holidays
- Up to 56 hours of Paid Sick Leave
- Vacation leave
- Telehealth plan
- Working Advantage discount purchase plan
- Balanceworks - Employee Assistance Program
HealthCare Resolution Services, Inc. (HCRS)
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