The Outpatient Coder/Abstractor is responsible for coding and abstracting selected data from clinical/client medical records to be used for reimbursement, marketing, utilization review and strategic planning purposes according to standards established by current law, regulations, and accrediting agencies. The Outpatient Coder/Abstractor is also responsible to review clinical orders for medical necessity, identifying and obtaining ABNs, as necessary. This individual performs in accordance with hospital standards and policies. Operates under minimal supervision.
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action.
Must have thorough understanding of ICD-10 Official Coding Guidelines for Coding and Reporting and AHA Coding Clinic; HCPCS/CPT coding systems and CPT Assistant and Coding Clinic for HCPCS guidelines; Medicare Outpatient Prospective Payment System (OPPS), and Ambulatory Payment Classification (APC).
Has knowledge of and abides by HIM.COD policies
Knowledge of healthcare industry, insurance industry, and current federal/state regulations governing billing practices.
Advanced reading and math skills.
Record keeping skills.
Relates to patients and peers to develop and maintain effective work/patient relationships.
Prioritizes work and meets changing demands and stress deadlines.
Effective oral and written communication and interpersonal skills and behaviors.
Follows procedures related to position accountabilities.
Working ability with word processing, typing skills and strong ability in spreadsheet or database applications.
Learns and applies analytical and participative problem solving techniques.
Extensive knowledge of medical terminology anatomy and physiology, medications and lab values.
Current knowledge of CPT and ICD-10-CM coding practices.
Advanced knowledge of Medicare local review policies and reimbursement methods.
Demonstrates responsibility and accountability according to legal, ethical, professional, educational and personal development goals.
Updates and develops continuous skills.
Two years previous related experience in coding field, preferred.
Certifications: Requires certification as Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) in any area.
High School Diploma Required