Outpatient Level 4 - Special Procedure Coder

The role of the Outpatient Level 4 – Special Procedure Coder is an advanced coder position to interact extensively with the physician and others members of the healthcare team to facilitate improvement in the overall quality, completeness and accuracy of medical record documentation. This will support the appropriate clinical picture and level of severity of the patient, while providing accurate and complete information that is utilized in the medical record and core measure abstraction and coding process to obtain appropriate reimbursement. This position will identify opportunities for documentation improvement to ensure accuracy and completeness of documentation used for measuring and reporting physician and quality hospital outcomes. The Coder Outpatient Level 4 – Special Procedure Coder will collaborate with other disciplines as necessary to communicate these opportunities for referral to the appropriate performance improvement committee for resolution.

This is an advanced coder position responsible for reviewing outpatient hospital-based clinical documentation using nationally recognized guidelines to assign accurate and complete documentation of ICD-10-CM diagnostic codes, Current Procedural Terminology (CPT) procedures and modifiers, Evaluation & Management facility (E/M) code and group Ambulatory Payment Classifications (APC) for billing and processing National Correct Coding Initiative (NCCI) and payer-specific edits related to hospital coding. The Outpatient Level 4 – Special Procedure Coder processes codes for surgical encounters and follows the ICD-10-CM Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of Ethical Coding, and all American Hospital Association (AHA) Coding Clinics for HCPCS and the American Medical Association (AMA) CPT Assistant.

The Outpatient Level 4 – Special Procedure Coder serves as a subject matter expert for hospital coding and interacts with other teams and departments across the organization such as Patient Financial Services, the Patient Billing Office, Revenue Integrity (Charge Description Master), Outpatient Level 3 – Special Procedure Coder team, provider teams and/or Compliance on a routine basis. Additionally, this position interacts with physicians, operational and clinical mangers and many other clinical roles throughout the enterprise. The Outpatient Level 4 – Special Procedure Coder follows policies and procedures and maintains required quality and productivity standards while remaining compliant with third-party, state and federal regulations. In addition to traditional coding-related activities, responsibilities also include reviewing and resolving medical necessity edits that may apply to any outpatient surgical encounters, applying hospital modifiers to CPT codes, processing any errors associated with the revenue cycle process, and collaborating on summarizing findings for provider documentation optimization opportunities. When necessary, Special Procedure Coder Specialist may assist in the design and implementation of workflow changes to reduce coding and billing errors.

The Outpatient Level 4 – Special Procedure Coder is distinguished from Outpatient Coder – Level 3 by mastering more than one specialty and/or possessing coding certification in two specialties.

QUALIFICATIONS

• EDUCATION: High school diploma required. Associate of Science degree in Health Information Technology preferred. Bachelor's of Science HIM preferred. RHIA or RHIT preferred.
• LICENSE/CERTIFICATION: CPC, COC (previously CPC-H) or CIRCC for advanced knowledge of interventional radiology and interventional cardiology coding required. Successful completion of a college-based coding program or college-based coding certificate program preferred (AHIMA-approved preferred). CIRCC preferred.
• EXPERIENCE: Minimum 5 years of outpatient hospital-based coding (recent hands on production) experience required. Must be proficient in coding surgical encounter specialties. Minimum 1 year of experience with hospital-based highly specialized radiology, interventional radiology and cardiology cases required. Proficiency in clinical and business applications preferred at time of hire. Incumbents within position will be trained appropriately and then skill will be required for this position within 30-60 days from date of hire.

PERFORMANCE EXPECTATIONS
Demonstrates the technical competencies as established on the Assessment and Evaluation Tool.

WORK ENVIRONMENT
This active position requires the ability to work in a busy patient care area. Near visual acuity, long periods of visually examining documents and electronic files, and skilled use of multiple computer applications required. The Outpatient Level 4 – Special Procedure Coder works independently and autonomously with minimal supervision. Critical thinking and strong customer service skills required and ability to manage daily work duties accurately and efficiently.

The essential functions for this position are listed on the Assessment and Evaluation Tool.

REPORTING RELATIONSHIP
This position reports to department leadership.

The above statement reflects the general details considered necessary to describe the principal functions of the job as identified and shall not be considered as a detailed description of all work requirements that may be inherent in the position.