Outpatient Coder II, Physicians Central Billing Office

Professional Lawrence, Kansas


Description

Monday-Friday 8am-5pm

I. JOB SUMMARY


The Outpatient Coder is responsible for accurate claims filing, documentation review and claims denial processing for physician practices.  Under the direction of the Director, the Coder performs duties and provides education to the staff and physicians regarding the billing and charging process.  Displays flexibility regarding work assignments, receptionist and clerical duties for physician practices.  The Coder has additional combined responsibilities of data quality and insurance representative functions.

II. ESSENTIAL JOB RESPONSIBILITIES

  1. Demonstrates behavior consistent with PRIDE and the Visions and Goals of Lawrence Memorial Hospital.
  2. Reviews outpatient medical records to identify the principal diagnosis and all applicable secondary diagnosis and procedures.
  3. Use computerized encoding system to facilitate accurate coding according to the appropriate classification system.
  4. Sequence diagnosis and procedures by following ICD-9/ICD-10 CM, CPT/HCPCS, UHDDS, CMS and other fiscal intermediary guidelines.
  5. Work cooperatively with medical staff and other healthcare professionals in obtaining documentation to ensure optimal hospital payment and accurate data input.
  6. Prepare workload reports and participates in department continuous quality improvement studies.
  7. Abstract medical data from the record to complete discharge data abstract on each outpatient.
  8. Complete and verify diagnostic, demographic and other information for submission to KHDS.
  9. Review, verify, and initiate necessary correction processes for data quality review.
  10. Analysis of data for trends, quality improvement benchmarks, and HEDIS measures.
  11. Complete and analyze insurance quality program documentation.
  12. Answers patient billing questions and assists with resubmission or appeals processes.
  13. Participates in medical record documentation auditing to monitor physician compliance with regulatory requirements.
  14. Communicate and advise other hospital personnel on coding assignment.
  15. Meet established quality and productivity standards.
  16. Adhere to all hospital and departmental policies, procedures and regulations, including attendance.
  17. Perform other related duties as assigned or requested.
III. JOB QUALIFICATIONS
Required:  
  • High School Diploma or equivalent
  • CPC credentialed with 3 to 5 years experience
  • OR, RHIT, RHIA or CCS credentialed through AHIMA or in progress   
Preferred:
  • Associates or Bachelor’s degree in Health Information Management
  • ICD-10 knowledge
IV. BEHAVIORAL EXPECTATIONS (common to all positions)
  • Patient 1st – We consider the patient first in everything we do.
  • Better Together – We are part of the LMH team that works together to achieve excellence.
  • Speak Up – We embrace a transparent culture of open, respectful communication where ideas are valued and solutions are created.
  • Innovate! – We actively explore new ideas and approach change with agility and an open mind.
  • Own It/Solve It – We hold ourselves accountable for our actions and we collaborate for solutions.
  • In Joy – We create a workplace that is both fun and meaningful.

At LMH Health we value inclusion and diversity. We are an equal opportunity employer and encourage all to apply.  Employment is decided on the basis of experience and qualifications that meet the business need.