Role Description
The Outpatient Lab Coder will be responsible for advanced coding position that requires review of medical record documentation and accurately assigns ICD-10-CM, ICD-10 PCS, CPT IV codes, as well as assignment of the Medicare Severity Diagnosis Related Group (MS-DRG) / All Patient Refined - Diagnosis Related Group (APR-DRG) based on payor classification and abstracts specific data elements for each case in compliance with federal regulations. This position codes all types of inpatient and outpatient records and follows the Official Guidelines of Coding and Reporting, the American Health Information Management Association (AHIMA) Coding Ethics, as well as all American Hospital Association (AHA) Coding Clinics, CMS directives and bulletins, Fiscal intermediary communications.
Qualifications
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Minimum Education: High School Diploma/GED Required
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Required Certifications: Coding Certification Required - RHIT/RHIA/CCS/CIC/CPC
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Must be able to read, write and speak the English language in an understandable manner.
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Must function independently, have flexibility, personal integrity, and the ability to work effectively with co-workers, and personnel of other departments.
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Must have computational skills and knowledge of computer.
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Extensive knowledge of medical terminology
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Data entry skills
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Problem-solving skills
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Attention to detail
Requirements
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Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, leading to the assignment of the correct Medicare Severity-Diagnosis Related Group (MS-DRG) or All Patient Refined Diagnosis Related Group (APR-DRG).
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Correctly abstract required data per facility specifications.
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Responsible to assist with writing appeals for Diagnosis Related Group (DRG) denials in order to support the assigned Diagnosis Related Group (DRG) and to address the clinical documentation utilized in the decision-making process to support the validity of the assigned codes.
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Responsible for monitoring and working of accounts that are Discharged Not Final Billed, failed claims, stop bills, and as a team, ensure timely, compliant processing of inpatient/outpatient accounts through the billing system.
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Collaborates with coding team and members of the medical staff to ensure completeness of documentation in the charts so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG), may be assigned.
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Responsible for ensuring accuracy and maintaining established quality, productivity standards, and key performance indicators.
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Remain abreast of current Centers for Medicare and Medicaid Services (CMS) requirements as well as Correct Coding Initiative (CCI) edits, Hospital Acquired Conditions (HAC's) and when applicable, National Coverage Determinations (NCDs) and Local Coverage Determinations (LCDs), including the addition of appropriate modifiers to ensure a clean claim the first time through.
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Other related duties as assigned.
Benefits
