Sauk Prairie Healthcare
Medical Coding Specialist - Outpatient
Full-Time
No salary listed
Entry
Associate's
Wisconsin, USA+1 more
More locations: Illinois, USA
Remote
Wisconsin or Illinois residency required; fully remote with an option to work onsite.
About the job
Requirements
- Successful completion of a professional American Health Information Management or American Academy of Professional Coders recognized coding course and/or an associate degree in a healthcare-related program.
- No prior experience is required.
- Must obtain credentials through the American Health Information Management Association or American Academy of Professional Coders within six months of hire and maintain the credential thereafter.
- Must obtain one of the following credentials: Registered Health Information Technician, Registered Health Information Administrator, Certified Coding Associate, Certified Coding Specialist, Certified Professional Coder – Hospital, Certified Professional Coder, Certified Inpatient Coder, or Certified Outpatient Coder.
Responsibilities
- Review medical reports and physician documentation for clinic and hospital outpatient services and apply diagnostic and procedural codes to patient health information for claims processing, data retrieval, and analysis.
- Assign codes for ambulatory outpatient facility and professional services using International Classification of Diseases and Current Procedural Terminology coding protocols, including professional coding for Emergency Room and Urgent Care providers as needed.
- Audit electronic medical records for accurate patient and insurance information, diagnoses, procedure codes, and documentation supporting billing and reimbursement.
- Review and resolve National Correct Coding Initiative and Outpatient Code Editor edits.
- Communicate with clinical department directors and medical billing staff to clarify coding guidelines and resolve claim edits.
- Identify and communicate missed revenue opportunities to ambulatory departments and work with a business analyst to create new charge codes as needed.
- Investigate denied claims from insurance carriers and submit timely appeals to ensure accurate reimbursement.
- Abstract pertinent information from patient records using the hospital information system.
- Query physicians to clarify documentation or code assignment.
- Identify coding concerns or trends and involve Revenue Cycle leadership in resolution as needed.
- Provide education on coding changes.
- Attend continuing education programs and review educational resources to stay current on coding changes and support coding recertification.
- Assist with developing coding-related policies and procedures.
- Assist with training new employees and job shadowing.
- Perform other related work assignments as required.
Desired Qualifications
- Prior ambulatory coding experience.
- An associate degree in a healthcare-related program.