JOB SUMMARY

Provide the outpatient coding skills necessary for the coding of all diagnoses and procedures after a thorough review of medical record for optimal reimbursement.

Job Specific:

• Responsible for coding and abstracting outpatient accounts, not to exceed a bill hold status of three (3) days post the date of service/discharge.(EF)
• Maintains productivity standards for assigned work type with a minimum of 95% accuracy(EF)
  • Observation = 5/hours
  • Emergency Department = 15/hour
  • Outpatient Testing = 30/hour
  • Ambulatory Surgery = 5/hour
  • Inpatient = 2/hour
• Assigns ICD-10-CM/PCS and CPT codes with accuracy, ensuring that all assigned codes have adequate physician documentation.(EF)
• Understands computer systems and possesses the ability to reconcile various accounts, charges, including correcting discharge dates, and requesting billing to link accounts, as necessary.(EF)
• Works independently in coding as a remote employee. Troubleshoots and assists analysis of system issues independently with IT assistance.
• At the start of each day, review your virtual and coding worklists in Optum to prioritize work.
• Reviews medical record for medical diagnosis/procedures ensuring assignment of all diagnosis treated and procedures performed.(EF)
• Analyzes charges for edits and pends account for charge review and/or modifier correction to ensure an accurate claim at the time of billing.
• Utilizes Optum computer-assisted coding and encoder to assign ICD-10-CM/PCS codes, CPT codes, and modifiers and validates the E&M level based on the medical record documentation.(EF)
• Approves the code assignment by sending account to billing.(EF)
• Completes physician and/or provider query for documentation clarification/missing documentation when appropriate.

Hospital:

• Adheres to organization-wide and other applicable policies and procedures.
• Day-to-day performance complies with the hospital’s Service Excellence Behavioral Expectations.
• Performs within the prescribed limits of the hospital’s Ethics, Compliance and Confidentiality Program guidelines.
• Performs within professional Scope of Practice at all times.

Other Duties As Assigned:

• Nothing in this job description restricts management’s right to assign or reassign duties and responsibilities to this job at any time.

EDUCATIONAL REQUIREMENTS

Required: Successful completion of an approved coding program

Preferred: Associate’s degree in health-related field OR possess preferred licensure/certification listed below along with high school diploma.

EXPERIENCE

Preferred: Six (6) months coding experience in an inpatient or outpatient setting.

Special Skills and Abilities

Required: Entry level ICD-10-CM/PCS and CPT coding knowledge.

Preferred: Advanced Outpatient ICD-10-CM/PCS and CPT coding knowledge and scoring a minimum of 80% on pre-employment coding test.

LICENSURE / CERTIFICATION REQUIREMENTS

Required: Certificate of completion of approved coding program

Preferred: AHIMA Certified Coding Associate (CCA) or AAPC Certified Professional Coder (CPC)

COMPANY PROFILE

Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted “Best of the Best” hospital in Victoria for 13 consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.