Senior Outpatient Coder at Quorum Health
United States
<p><strong>Senior Outpatient Coder</strong></p> <p><strong>Position Details:<br /></strong>Full-Time Remote<br />Reports to Coding Operations Manager</p> <p><strong>You must reside in one of these states to be eligible for this position:</strong></p> <p>Arkansas    California    Kentucky<br />Massachusetts Nevada    New Mexico<br />Oregon     Utah     Tennessee<br />Texas     Wyoming</p> <p><strong>Job Summary:</strong></p> <ul> <li>The Senior Coder supports assigned inpatient and/or outpatient coding operations through day-to-day workflow leadership and may provide oversight of coding quality, coding edits, auditing, and staff education.</li> <li>Assigned functions may include inpatient, observation, emergency department, ambulatory surgery, ancillary, clinic, and other hospital-based coding services.</li> <li>The position supports Revenue Cycle Operations with special projects, including denial review, appeals, discharge-not-final-billed management, regulatory and payer edit review, and process improvement efforts designed to meet organizational goals while promoting accurate, complete, and compliant coding and billing.</li> </ul> <p><strong>Duties and Responsibilities:</strong></p> <ul> <li>Provides day-to-day leadership and operational support for assigned inpatient and/or outpatient coding workflows, work queues, facilities, and coding staff, consistent with delegated authority.</li> <li>Provides direct support to Coding Management, including process improvement, denials, special projects, coding edits, auditing, staff education, and other duties as assigned.</li> <li>Applies current official coding guidelines and authoritative guidance, including ICD-10-CM/PCS, CPT, HCPCS, UHDDS, Coding Clinic, CMS payment rules, and applicable payer requirements.</li> <li>Maintains at least 95% coding accuracy, or another threshold established by Coding Leadership, using the organization's approved audit methodology.</li> <li>Monitors coder productivity and quality at established intervals and provides timely, objective feedback, coaching, and education as directed by Coding Management.</li> <li>Ensures encounters processed by the coding team include an appropriate documented claim-hold reason before the account appears on the DNFB report.</li> <li>Collaborates with the CDI/Audit team to confirm second-level review is completed for applicable HAC, PSI, and Never Event cases in accordance with established workflows.</li> <li>Tracks and trends post-discharge coding queries, supports timely resolution, and provides feedback and education to ensure queries are non-leading, supported by the health record, and compliant with organizational policy and applicable guidance.</li> <li>Ensures accounts are not final billed until required documentation is available and assigned codes are supported by the health record, consistent with organizational policy and applicable billing requirements.</li> <li>Coordinate workflow improvements with HIM Operations Team(s).</li> <li>Assists in developing, implementing, and monitoring coding policies and procedures that support accurate coding, appropriate reimbursement, and compliance with federal and state laws, regulations, official coding guidelines, and payer requirements.</li> <li>Supports effective collaboration between Coding and CDI staff while maintaining role-appropriate accountability and compliant query practices.</li> <li>Adheres to the AHIMA Standards of Ethical Coding, the organizational code of conduct, and applicable compliance policies, and promotes compliant coding practices within assigned workflows.</li> <li>Maintains Discharged Not Final Billed goals established by Coding Leadership without compromising coding accuracy, documentation requirements, or compliance.</li> <li>Ensures coding policies related to HIM, Revenue Cycle, and Compliance are implemented and monitored within assigned areas.</li> <li>Implements HIM related projects at the direction of Coding Leadership.</li> <li>Supports Quality, Risk Management, Case Management, and other departments regarding HIM and coding matters within the scope of the role.</li> <li>Assists HIM, Coding, and CDI Leadership with the development and implementation of coding and CDI policies and procedures.</li> <li>Monitors and communicates changes in federal and state laws, regulations, accreditation standards, official coding guidance, CMS NCCI/OCE/MUE edits, and payer requirements that affect Coding and HIM operations.</li> <li>May develop and deliver staff education, coaching, and reference materials based on audit findings, coding-edit trends, denial trends, regulatory changes, and identified knowledge gaps; documents education as required.</li> <li>May research, review, resolve, and trend coding edits, including NCCI, OCE, MUE, encoder, claim-scrubber, and payer-specific edits; validates that any modifier or code change is supported by the health record and applicable guidance.</li> <li>May perform or support prospective, concurrent, and retrospective coding audits using an approved methodology; documents findings, identifies trends and potential overpayments or underpayments, and escalates compliance concerns through established channels.</li> <li>Protects the confidentiality, integrity, and security of protected health information and accesses only information necessary to perform assigned duties in accordance with HIPAA and organizational policy.</li> <li>Promptly reports suspected coding, billing, privacy, or compliance concerns through established channels and supports corrective action; does not alter the health record or direct unsupported coding.</li> </ul> <p><strong>Knowledge, Skills and Abilities:</strong></p> <ul> <li>Extensive knowledge of OPPS, IPPS, UHDDS, Coding Clinic, official coding guidelines, CMS NCCI/OCE edits, and applicable reimbursement methodologies.</li> <li>Microsoft Office (Word, One Note, Excel, Outlook, PowerPoint)</li> <li>Ability to interpret audit findings, coding-edit logic, and payer requirements and translate findings into staff education and process improvement.</li> <li>Ability to maintain objectivity, confidentiality, and accurate audit documentation and to communicate compliance concerns through established channels.</li> <li>Excellent verbal and written communication skills.</li> <li>Ability to meet assigned deadlines.</li> <li>Extensive knowledge of Anatomy & Physiology, Medical Terminology, and Pathophysiology.</li> </ul> <p><strong>Work Experience, Education and Certifications:</strong></p> <ul> <li><strong>EDUCATION: </strong>CCS Credential, RHIT or RHIA</li> <li><strong>EXPERIENCE: </strong>5-10 years progressive HIM coding management experience within an acute care hospital setting. Extensive experience with Revenue Cycle Operations including acute care coding</li> <li><strong>CERTIFICATION/LICENSURE: </strong>RHIA or RHIT or CCS</li> <li><strong>SOFTWARE/HARDWARE: </strong>3M 360 experience required</li> </ul> <p><strong>Travel Requirements:</strong></p> <ul> <li>Expected travel is up to 10% at the request of leadership.</li> </ul> <p><strong>Benefits:</strong></p> <ul> <li>Competitive salary and benefits package.</li> <li>Opportunities for professional development and advancement.</li> <li>Supportive work environment with a collaborative team.</li> <li>Comprehensive healthcare coverage.</li> <li>Retirement savings plan.</li> <li>Paid time off and flexible scheduling options.</li> <li>Student loan repayment program.</li> </ul>
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