Work Shift:

Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advance technology. Capital Health is a five-time Magnet-Recognized health system for nursing excellence and is comprised of 2 hospitals. Capital Health Medical Group is made up of more than 250 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region.

Position Overview:

VERSION:

2.2

JOB TITLE:

HIM Coding Rev Spec Outpatient

COST CENTER:

000000

JOB CODE:

20311

FLSA Exemption Status:

Exempt

Telecommuting Eligible:

Yes

SUMMARY (Basic Purpose of the Job)

The HIM Outpatient Coding Rev Spec provides expertise in development and maintenance of rules, policies and procedures to ensure organizational compliance with industry standard coding rules and guidelines. Interprets and applies National Uniform Billing Compliance rules, guidelines, laws and industry trends to support claims payment, provider reimbursement and system configuration to proactively address cost efficiencies and compliance requirements. Recommends clinical classification and reimbursement guidelines and standards. Reviews coding in provider contracts and participates in development of coding standards for provider contracts. Performs health data analytics related to reimbursement business and policy decisions.

MINIMUM REQUIREMENTS

Education:

High School diploma or equivalent. Associate's degree preferred. COC or CPC required.

Experience:

Two years of medical or hospital coding experience.

Other Credentials:

CPC

Knowledge and Skills:

Prior experience with an encoder and EMR computer system. Possesses excellent organizational, interpersonal, verbal, and written communication skills. Knowledge of denials management preferred.

Special Training:

Instructed in APC assignment and the application of the requirements needed to comply with federal and local regulations.

Mental, Behavioral and Emotional Abilities:

Ability to effectively manage multiple projects simultaneously and ability to respond quickly in a fast paced environment.

Usual Work Day:

8 Hours  

Reporting Relationships

Does this position formally supervise employees? No

ESSENTIAL FUNCTIONSVerifies accurate assignment of diagnoses and procedures within the medical record to comply with federal and state regulations.Acts as the primary department expert on APCs while consistently monitoring regulatory updates and their implementation including NCCI, OCE, NCD, and LCD edits.Conducts regular audits and reviews of medical records at a senior level and assists with external and internal reviews for coding accuracy.Reviews claim denials and rejections pertaining to coding and medical necessity issues and exercises discretion and judgement when recommending corrective action plans such as educational programs to prevent similar denials and rejections from occurring in the future.Assists in implementation of policy and procedural changes within the department regarding coding and quality issues required by third party payers and according to recommendations by coding consultants and agencies.Develops and coordinates educational and training programs on coding and documentation for department staff, physicians, billing staff, and ancillary departments.Provides management with various statistical reports, data, and audits information on health information management compliance issues, internal and external quality assurance results and activities, performance improvement activities and other statistical information as required or requested.Adapts to changing department demands required for higher department efficiency.Liaises with Quality and other departments for validation to ensure accurate external reporting. Assists other departments with ICD-10-CM and CPT code requests.Performs other duties as assigned.

PHYSICAL DEMANDS AND WORK ENVIRONMENT

Frequent physical demands include:

Occasional physical demands include: Standing , Walking , Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching overhead , Squat/kneel/crawl , Talk or Hear

Continuous physical demands include: Sitting , Reaching forward , Wrist position deviation , Pinching/fine motor activities , Keyboard use/repetitive motion

Lifting Floor to Waist 15 lbs. Lifting Waist Level and Above 15 lbs.

Sensory Requirements include: Accurate Near Vision, Accurate Far Vision, Accurate Depth Perception, Accurate Hearing

Anticipated Occupational Exposure Risks Include the following: Uneven Surfaces or Elevations , Dust/Particulate Matter

Offers are contingent upon successful completion of our onboarding process and pre-employment physical.  Capital Health will require all applicants to have an annual flu vaccine prior to start date, with the exception of individuals with medical and religious exemptions.

"Company will never ask candidates for social security numbers or date of birth during application phase. If you are asked for this information online, you may be a target for identity theft."