Job Details

HIM Outpatient Coding Rev Spec

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 Functions

• Verifies 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: 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.

The pay rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.

The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.