O/P Specialty Coder

Yale-New Haven Health New Haven , CT 06501

Posted 1 week ago

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values-integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.



Performs a variety of complex coding activities including but not limited to charging, analysis of specialty services and the ability to code all other case types for a Coder 1 and Coder 2 to ensure department revenue integrity is maintained and billing is compliant. This information acts as a mechanism for indexing medical information; which is used for research, utilization, appropriateness of care, compilation of statistics for hospital, regional and government, and accurate reimbursement.

Evaluates and monitors claims for accuracy prior to claim submission to ensure that it is correct as well as compliant. Interacts with other departments to maintain accurate revenue integrity and compliance. Mentors beginner coders and cross-trains others. Acts as an expert specialty coding resource to other coders and other hospital departments when coding questions /issues arise.


1.Analyzes and codes patient encounters in a timely and accurate manner to ensure quality data and timely billing. 1.1. Completes assigned work ensuring department benchmarks are met or exceeded consistently in accordance with current industry standards and use of current technologies. 1.2. Ensures all available records are coded to meet OP coding minimum days/CFB. 1.3. Monitors and works "Bill Edit Report" on a daily basis in order to maintain the departmental goal. 1.4. Assigns ICD-10 and CPT codes and ensures consistency between procedures charged for, using the charge master and clinical evidence within the documentation achieving an accuracy rate of 95% or greater. 1.5. Assigns correct surgeon and date of procedures with an accuracy rate of 95% or greater including correct sequencing of codes. 1.6. Independently researches all coding problems, using all resources including but not limited to Encoder/CAC prior to seeking help from the supervisor or coding specialist. 1.7. Reviews and corrects any initial coding edits. 1.8. Analyzes problems as they pertain to patient records and accounts and recommends corrective action. Assists the business office and revenue integrity in clarification of charges and coding versus reimbursement issues. 1.9. Assigns ICD-10-CM and PCS and CPT codes and ensures consistency between procedures charged for and clinical evidence , using the charge master within the documentation achieving an accuracy rate of 95% or greater. 1.10. Demonstrates knowledge of all job functions within the outpatient coding area and is able to cross-train others and provide coverage as needed. 1.11. Sequences ICD-10-CM codes appropriately to ensure correct APC assignment and hospital reimbursement. 2. Special Skills HCPCs / CPT 2.1. Interacts with other departments (i.e. Charge Master and Pharmacy) to maintain accurate revenue integrity and compliance completing required documentation to monitor and track issues and corrections. 2.2. Assigns and reviews HCPCS coding and units charged with 100% charge review for documentation after validation. 2.3. Identifies documentation opportunities and queries providers as appropriate; places account on hold for follow-ups to ensure timely final coding on outstanding account queries. 3. Performs a variety of departmental administrative tasks and coding related duties to assure the efficient operation of the department. 3.1. Maintains Coding Certification (i.e. CCS/CPC/ COC/CIRCC) yearly by complying with requirements set forth by AHIMA and/or AAPC. 3.2. Analyzes the unbilled report to bill charges timely as well as identifies trends to avoid future billing delays. 3.3. Identifies inconsistencies in the coding or charging which could impact department efficiency and accuracy. Makes recommendations to streamline activities and procedures to support the coding unit. 3.4. Review and respond to quality and compliance audits within the required response period using the assigned documentation format. 4. Maintains professional skills and remains engaged in the goals and vision of the organization to ensure the department functions efficiently and accurately with integrity. 4.1. Actively participates in staff meetings and offers constructive suggestions for improving the process. 4.2. Identifies and reports all procedures and findings that are not accurate. 4.3. Reviews all memos, emails and policy updates as they are distributed to ensure current coding and billing procedures are followed. 4.4. Participates in career development activities by utilizing American Coding School, reading journals and coding articles and attending coding educational in-services and webinars. 4.5. Complies with all aspects of telecommuting agreement and participates in all mandatory training and/or staff meetings. Reports to work on-site as requested. 4.6. During periods of heavy workload, will provide assistance to other work areas as needed and will exercise good judgment and demonstrate flexibility. 4.7. Maintains skills with ICD-10-CM, ICD-10-PCS and CPT-4 through the use of Coding Books and/or utilizes Encoder/CAC to ensure current resources are referenced to assure accurate and up-to-date code assignments. 4.8. Assist in cross training of staff as needed and requested by coding leadership. 4.9. Maintain certifications required for position

Other information:


High School Diploma required. Associate's degree preferred.

Certified Coding Specialist (CCS), Certified Coding Specialist Physician based (CCS-P) certification through the American Health Information Management Association (AHIMA) and/or Certified Professional Coder (CPC) and/or Certified Outpatient Coder (COC) through American Academy of Professional Coders (AAPC) is required. CIRCC certification Preferred.


With high school diploma

  • CPC, COC, or CCS with a minimum of six (6) years coding experience. With an Associate's degree

  • CPC, COC, CCS with four (4) years of coding experience. Coding and billing related claim edits experience required. Work includes coding complex Cardiac Catheterization/Interventional specialty outpatient accounts.


Either CPC, COC, CCS required. CIRCC Preferred.


In-depth knowledge of medical terminology, anatomy, physiology, and disease process. Knowledge of coding, billing, and the revenue cycle.

Demonstrated knowledge of medical terminology and organization of the medical record coding systems. Comprehensive understanding of ICD-10-CM classification systems, and Medicare/Medicaid Evaluation & Management (E&M), Outpatient Prospective Payment System (OPPS) and Ambulatory Payment Classification (APC's). Good oral and written communication skills. Experience with HCPCS coding and pharmaceutical drug types/pricing.


Responsible for accurate selection of diagnoses and procedures and appropriate codes; determination of correct principle diagnosis and procedure; timely coding and subsequent charge review and corrections into hospital billing system, maintenance of 95% coding accuracy rate.


Exercises independent judgment in determining appropriate diagnostic and procedure data from all types of medical record documentation and physician communication. Assists supervisor in the quality review process as well as makes suggestions and implements workflow and procedures under the direction of Supervisor/Manager. Work includes the most complex specialty outpatient coding (Heart and Vascular, Interventional Radiology, etc.).

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O/P Specialty Coder

Yale-New Haven Health