Trinity Health
Coder III Complex Outpatient Observation/Ambulatory Surgery (REMOTE)
Trinity Health, New York, New York, United States
Employment Type:
Full time Shift:
Day Shift Description:
Provides high-level technical competency and subject matter expertise in analyzing physician/provider documentation contained in Complex Outpatient (CO)/Ambulatory Surgery health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Ambulatory Procedure Classification (APC) codes, required modifiers, NCCI, and LCD/NCD edits. Utilizes encoder software applications, including all applicable online tools and references, to assign ICD-CM diagnosis and procedure codes, CPT, and HCPCS codes. Uses encoder software and coding abstracting system edit features to resolve edits before completing coding. Interprets, researches, and resolves claim edits that occur after coding to support timely final claims submission. Assigns appropriate code(s) by utilizing coding guidelines established by: The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting American Hospital Association (AHA) Coding Clinic for ICD, ICD-PCS The American Medical Association (AMA) for CPT codes and CPT Assistant American Health Information Management Association (AHIMA) Standards of Ethical Coding Revenue Excellence/Health Ministry (HM) coding procedures and guidelines
ESSENTIAL FUNCTIONS
Demonstrates understanding and incorporation of the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Navigates patient health records and other systems to accurately determine diagnosis and procedure codes, APCs, modifiers, and edits impacting reimbursement. Interprets bundling/unbundling guidelines (NCCI edits), LCDs/NCDs, and payer policies. Works out outpatient claim edits and routes non-coding issues to appropriate teams. Adheres to coding quality and productivity standards. Uses current, compliant practices when consulting with healthcare providers for additional documentation or clarification. Utilizes EMR tools to track documentation gaps or queries for timely coding. Collaborates with HIM and Patient Business Services teams to resolve billing and claims issues. Maintains CEUs as required for credentials. Stays updated on coding and reimbursement guideline changes. Identifies workflow issues impacting coding and reports concerns. Maintains awareness of documentation and coding ethics, notifying leadership as needed. Performs other duties as assigned. Ensures compliance with applicable laws, regulations, and policies reflecting ethical and professional standards. MINIMUM QUALIFICATIONS
Completion of an AHIMA or AAPC approved coding program, Associates degree in Health Information Management or related field, or equivalent experience. Bachelors degree preferred. RHIT, RHIA, or CCS certification required. Minimum three years of current acute care or outpatient coding experience. Strong knowledge of medical terminology, anatomy, physiology, and coding. Proficient in identifying NCCI, LCD/NCD edits for accurate reimbursement. Experience with encoding/grouping software and CAC preferred. Proficiency with desktop applications, email, and internet tools. Effective communication skills and ability to research and analyze information critically. Excellent organizational skills, adaptability, and capacity to work independently in a virtual environment. Personal qualities of honesty, integrity, and motivation aligned with Trinity Healths values. PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Ability to prioritize and adapt to changing work environments. Capable of working on multiple tasks, often under stress. Must be able to work primarily at a computer, with occasional travel to Trinity Health sites. If telecommuting, must comply with remote work policies. Hourly Pay Range:
$27.96 - 41.95 Note: This description outlines the general responsibilities and is not exhaustive of all duties. Our Commitment Rooted in our Mission and Core Values, we honor every persons dignity and unique talents. We promote diversity, equity, and inclusion, and are an Equal Opportunity Employer. All qualified applicants will be considered without regard to protected statuses. #J-18808-Ljbffr
Full time Shift:
Day Shift Description:
Provides high-level technical competency and subject matter expertise in analyzing physician/provider documentation contained in Complex Outpatient (CO)/Ambulatory Surgery health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Ambulatory Procedure Classification (APC) codes, required modifiers, NCCI, and LCD/NCD edits. Utilizes encoder software applications, including all applicable online tools and references, to assign ICD-CM diagnosis and procedure codes, CPT, and HCPCS codes. Uses encoder software and coding abstracting system edit features to resolve edits before completing coding. Interprets, researches, and resolves claim edits that occur after coding to support timely final claims submission. Assigns appropriate code(s) by utilizing coding guidelines established by: The Centers for Medicare/Medicaid Services (CMS) ICD-CM Official Coding Guidelines for Coding and Reporting, ICD-PCS Official Guidelines for Coding and Reporting American Hospital Association (AHA) Coding Clinic for ICD, ICD-PCS The American Medical Association (AMA) for CPT codes and CPT Assistant American Health Information Management Association (AHIMA) Standards of Ethical Coding Revenue Excellence/Health Ministry (HM) coding procedures and guidelines
ESSENTIAL FUNCTIONS
Demonstrates understanding and incorporation of the Trinity Health Mission, Vision, and Values in behaviors, practices, and decisions. Navigates patient health records and other systems to accurately determine diagnosis and procedure codes, APCs, modifiers, and edits impacting reimbursement. Interprets bundling/unbundling guidelines (NCCI edits), LCDs/NCDs, and payer policies. Works out outpatient claim edits and routes non-coding issues to appropriate teams. Adheres to coding quality and productivity standards. Uses current, compliant practices when consulting with healthcare providers for additional documentation or clarification. Utilizes EMR tools to track documentation gaps or queries for timely coding. Collaborates with HIM and Patient Business Services teams to resolve billing and claims issues. Maintains CEUs as required for credentials. Stays updated on coding and reimbursement guideline changes. Identifies workflow issues impacting coding and reports concerns. Maintains awareness of documentation and coding ethics, notifying leadership as needed. Performs other duties as assigned. Ensures compliance with applicable laws, regulations, and policies reflecting ethical and professional standards. MINIMUM QUALIFICATIONS
Completion of an AHIMA or AAPC approved coding program, Associates degree in Health Information Management or related field, or equivalent experience. Bachelors degree preferred. RHIT, RHIA, or CCS certification required. Minimum three years of current acute care or outpatient coding experience. Strong knowledge of medical terminology, anatomy, physiology, and coding. Proficient in identifying NCCI, LCD/NCD edits for accurate reimbursement. Experience with encoding/grouping software and CAC preferred. Proficiency with desktop applications, email, and internet tools. Effective communication skills and ability to research and analyze information critically. Excellent organizational skills, adaptability, and capacity to work independently in a virtual environment. Personal qualities of honesty, integrity, and motivation aligned with Trinity Healths values. PHYSICAL AND MENTAL REQUIREMENTS AND WORKING CONDITIONS
Ability to prioritize and adapt to changing work environments. Capable of working on multiple tasks, often under stress. Must be able to work primarily at a computer, with occasional travel to Trinity Health sites. If telecommuting, must comply with remote work policies. Hourly Pay Range:
$27.96 - 41.95 Note: This description outlines the general responsibilities and is not exhaustive of all duties. Our Commitment Rooted in our Mission and Core Values, we honor every persons dignity and unique talents. We promote diversity, equity, and inclusion, and are an Equal Opportunity Employer. All qualified applicants will be considered without regard to protected statuses. #J-18808-Ljbffr