Overview: 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.
Under the general direction of the OP Coding Supervisor, the Outpatient Coder 3 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in three (3) complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks, resolving claim edits, handling individual coding workload, working stop bills/DNBs, conducting QA reviews and sending queries, as needed, to clinical staff. Mentors Coder 1 and Coder 2 coders, and participates in cross-training initiatives such as the coder buddy program and learning circle initiatives. Acts as an expert coding resource to other coders and other hospital departments when coding questions /issues arise.

EEO/AA/Disability/Veteran Responsibilities:

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• Reviews medical record documentation and accurately selects the appropriate ICD-10-CM, CPT, modifiers, and ICD-10-PCS codes, when applicable, in accordance with official coding guidelines. This includes resolving CCI edits, as applicable.

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• Capable of coding a minimum of three (3) complex OP service lines, which would include: Cardiology, Interventional Radiology, Observation, Oncology, or Same Day Surgery at proficiency.

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• Maintains the productivity expectations as defined by the department for the OP coding service lines.

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• Maintains a minimum of 95% overall coding quality score in diagnostic, procedural, and modifier code selection in a minimum of three (3) complex OP coding service lines.

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• Participates and seeks out career development activities by reading journals, coding articles, researching procedures and/or disease processes to ensure appropriate code selection, regularly attends coding education sessions, and shares information. Actively participates, and/or leads learning circles or other educational initiatives.

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• Uses department resources regularly and follows workflows, with minimal assistance or intervention, to perform daily work to meet CFB (candidate for billing) goals.

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• Prioritizes coding workload appropriately by focusing efforts on cases and service lines with the potential to impact department goals with minimal supervision. Provides guidance to other coders, as appropriate.

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• Resolves cases returned coder for education and/or errors, and uses feed back to improve ongoing performance. Helps other coders, as directed, with resolving their errors.

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• Handles coding DNBs and stop bills, QA reviews, or other projects and/or coding initiatives as assigned. Must know the nuances of all the coding workflows.

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• Works with peers and/or leadership to create and maintain accurate up-to-date policies and procedures. May be the point person for peer-led documentation task forces and/or initiatives.

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• Mentors and provides coding support to peers and to new team members as part of the OP coder buddy program. Helps new team members acclimate into the coding environment.

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• Serves as a coding subject matter expert, and provides support to peers and to OP Coding leadership.

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• Exhibits enthusiasm for the profession, rembraces educational opportunities and department support offered and remains engaged in the goals and vision of the department.

Qualifications:

EDUCATION

Bachelors degree preferred in a health related field. Requires course work, preferably college level, in anatomy and physiology, medical terminology, pathophysiology, and disease process.

EXPERIENCE

Requires a minimum of four (4) years - 6 years of outpatient coding experience in multiple complex coding specialties to be considered. Prior experience in Epic and 3M encoder preferred.

SPECIAL SKILLS

Comprehensive knowledge of anatomy/physiology, medical terminology, ICD-10-CM/PCS, and CPT coding. Knowledge of professional E/M leveling required. Must possess excellent communications skills orally and in writing, strong critical thinking and reasoning skills, in addition to time management skills. Must be able to perform functions independently and under limited supervision. Must be able to prioritize individual workload. Must be able to build effective peer-to-peer working relationships and mentor other coders in coding, workflows, etc

• 
  
• Reviews medical record documentation and accurately selects the appropriate ICD-10-CM, CPT, modifiers, and ICD-10-PCS codes, when applicable, in accordance with official coding guidelines. This includes resolving CCI edits, as applicable.

• 
  
• Capable of coding a minimum of three (3) complex OP service lines, which would include: Cardiology, Interventional Radiology, Observation, Oncology, or Same Day Surgery at proficiency.

• 
  
• Maintains the productivity expectations as defined by the department for the OP coding service lines.

• 
  
• Maintains a minimum of 95% overall coding quality score in diagnostic, procedural, and modifier code selection in a minimum of three (3) complex OP coding service lines.

• 
  
• Participates and seeks out career development activities by reading journals, coding articles, researching procedures and/or disease processes to ensure appropriate code selection, regularly attends coding education sessions, and shares information. Actively participates, and/or leads learning circles or other educational initiatives.

• 
  
• Uses department resources regularly and follows workflows, with minimal assistance or intervention, to perform daily work to meet CFB (candidate for billing) goals.

• 
  
• Prioritizes coding workload appropriately by focusing efforts on cases and service lines with the potential to impact department goals with minimal supervision. Provides guidance to other coders, as appropriate.

• 
  
• Resolves cases returned coder for education and/or errors, and uses feed back to improve ongoing performance. Helps other coders, as directed, with resolving their errors.

• 
  
• Handles coding DNBs and stop bills, QA reviews, or other projects and/or coding initiatives as assigned. Must know the nuances of all the coding workflows.

• 
  
• Works with peers and/or leadership to create and maintain accurate up-to-date policies and procedures. May be the point person for peer-led documentation task forces and/or initiatives.

• 
  
• Mentors and provides coding support to peers and to new team members as part of the OP coder buddy program. Helps new team members acclimate into the coding environment.

• 
  
• Serves as a coding subject matter expert, and provides support to peers and to OP Coding leadership.

• 
  
• Exhibits enthusiasm for the profession, rembraces educational opportunities and department support offered and remains engaged in the goals and vision of the department