JOB SUMMARY

Codes medical information into the organization billing/abstracting systems for multiple facilities. Performs moderate to complex Outpatient Surgery, Gastrointestinal (GI) Procedure and Observation coding by assigning International Classification of Diseases (ICD), Current Procedural Terminology (CPT) codes, and HCC codes. Performs Emergency Department, ambulatory clinic, diagnostic, and ancillary coding. Adheres to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely and consistent codes.

MINIMUM REQUIREMENTS

• Education - Certification Program, Associate degree or coding certificate through approved American Academy of Professional Coders (AAPC), American Health Information Management Association (AHIMA) or other approved coding certification program.
• Experience - Two (2) years of coding experience in an acute care or ambulatory setting. Outpatient coding experience

KNOWLEDGE, SKILLS AND ABILITIES

• Demonstrates proficiency in utilizing official coding books as well as the electronic medical record and computer assisted coding/encoding software to facilitate code assignment.
• Demonstrates continuous learning as evidenced by personally developed reference materials, online publications etc., to stay abreast of new and revised guidelines, practices and terminology, for reference and application.
• Participates in on site, remote and/or external training workshops and training.
• Ability to pass internal coding test.
• Knowledge of electronic medical records and 3M or other Encoder System.
• Ability to concentrate for extended periods of time; ability to solve problems with close attention to detail and to work and make decisions independently.
• Knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process.
• Demonstrated competence in coding and correct extrapolation of official coding and select billing guidelines to specific coding situations.
• Basic computer skills

ESSENTIAL FUNCTIONS

• All team members are expected to be knowledgeable and compliant with Prisma Health’s values: Inspire health. Serve with compassion. Be the difference.
• Codes moderate to complex Outpatient Surgery, and Observation records from clinical documentation as well as Emergency department, ancillary and ambulatory clinic records; assigns modifiers as appropriate. Queries physician following established guidelines when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy.
• Adheres to department standards for productivity and accuracy. Operates under the general supervision of HIM Coding leadership.
• Reviews work queues daily to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines. Follows up on On-hold accounts daily for final coding.
• Responds to and follows up on priority accounts daily and any accounts assigned by Patient Financial services or Coding leader(s) for final coding. Communicates with leader when trending requests volumes impact productivity.
• Queries physician or clinical area following established guidelines when existing documentation is unclear or ambiguous following American Health Information Management Association (AHIMA) guidelines and established policy.
• Applies ICD and CPT codes to the Emergency department, outpatient ambulatory clinic records and ancillary service records based on review of clinical documentation and according to Official coding guidelines; assigns modifiers
• Performs other duties as assigned.

SUPERVISORY/MANAGEMENT RESPONSIBILITIES

• This is a non-management job that will report to a supervisor, manager, director or executive.