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Title: Hospital Outpatient Coder/ Professional Specialty Coder
Department: Revenue Cycle Resources
Reports To: Coding Manager
The Hospital Outpatient/Professional Specialty Coder will be responsible for complex specialty professional coding or hospital outpatient coding. They may also be responsible for other professional or outpatient hospital coding. They will ensure the timely and accurate coding of medical claims. Furthermore, they will ensure maximum reimbursement for services provided by utilizing sound knowledge of coding rules and regulations, best practice workflows, and the use of multiple software systems.
Location: Hastings or Holdrege, Nebraska, or Remote within Nebraska, Kansas, Tennessee, or Kentucky
Note: A Coding Competency Assessment Test will be provided for qualified applicants prior to their first interview.
Education and/or Experience:
• High School Diploma is required, Associates is preferred.
• Two to five years medical coding experience is required.
• Emergency department and observation facility coding experience preferred.
Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) required.
General Requirements/Job Duties:
Employee must have the skills, ability, and judgment to perform the following essential job duties and responsibilities with or without reasonable accommodation. Specific job duties will vary based upon client assignment. Employee will also abide by ruralMED’s policies as a condition of employment.
- Receive and review charge entry data from practice sites.
- Identify and investigate incomplete or missing charges.
- Abstracts clinical information; translates medical documentation into diagnoses and procedural codes while utilizing currently accepted coding and classification systems.
- Sequences codes according to established guidelines.
- Thoroughly analyzes and interprets medical information, medical diagnoses, and coding /classification systems, to ensure accuracy for prospective payment system reimbursement.
- Conducts training for physicians/staff on coding and or documentation practices.
- Maintains current knowledge of coding rules and regulations as designated by the AMA, Centers of Medicare and Medicaid Services (CMS), and other payers.
- Maintains proficient knowledge of EHR, as well as any other systems, required for performing required job duties.
- Communicates issues to management, including payer, system, or escalated account issues. Identifies medical necessity denial trends and provides suggestions for resolution.
- May perform other billing functions including claim submission, unpaid claims follow-up, and denial resolution.
- Participates in department meetings, in-service programs, and continuing education programs.
- Maintains a professional attitude with patients, visitors, physicians, office staff, and hospital personnel. Assures confidentiality of patient information, maintaining compliance with policies and procedures.
- Performs other duties as assigned.
Required Knowledge, Skills and Abilities:
- Knowledge of medical terminology is required.
- Proficient with Microsoft Office
Will have access to confidential information. Will be expected to abide by the organization’s privacy policies and regulations concerning this information.
- General office equipment to include: eFax, computer, telephone, etc.
Essential Work Environment & Physical Requirements:
The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.