Coder II

OhioHealth; United States; Remote; USD 65,000 - 90,000; Full time

Job summary

OhioHealth is seeking a facility coder to perform outpatient coding and abstracting across multiple areas including Emergency Department, Diagnostics, Ambulatory Surgery and clinics. The role requires accurate ICD-9/ICD-10 and CPT coding, adherence to CMS guidelines, and documentation review to support appropriate charges.

AAPC/AHIMA credentials (RHIA/RHIT) and strong analytical skills are preferred. This position is office-based within the OhioHealth system and supports RAC audits as needed.

Qualifications

• High school diploma or GED required.
• AAPC or AHIMA certification (RHIA/RHIT) preferred.
• Knowledge of ICD-9, ICD-10 and CPT-4 classification systems.
• Strong analytical and critical-thinking skills; ability to resolve coding discrepancies.

Responsibilities

• Assigns appropriate admit, reason for visit, principal and secondary ICD-9/ICD-10 and CPT-4 diagnoses and/or procedures by reading documentation and applying coding guidelines.
• Reviews records for medical necessity according to CMS LCD/NCD guidelines; ensures correct E/M level and charges.
• Obtains physician clarification when documentation is inadequate or unclear for coding purposes.
• Abstracts data to complete UB-04 and supports RAC denials review.
• Verifies demographics, charges, service forms, and identifies missing/incorrect forms.
• Identifies DNFB issues and forwards to appropriate staff for follow-up.

Skills

Medical coding

ICD-10 / ICD-9 coding

CPT coding

Hospital coding

Education

High School Diploma or GED

AAPC / AHIMA certification (RHIA/RHIT)

Tools

HBOC system

GE Gentricity

Mosaic

Job description

We are more than a health system. We are a belief system. We believe wellness and sickness are both part of a lifelong partnership, and that everyone could use an expert guide. We work hard, care deeply and reach further to help people uncover their own power to be healthy. We inspire hope. We learn, grow, and achieve more – in our careers and in our communities.

Job Description Summary:

This position performs facility coding and abstracting functions of outpatient cases including Emergency Department, Diagnostics, MSF and Recurring Patient type, Ambulatory Surgery, Observation, Outpatient in a Bed, and/or Clinic charging and coding of accounts.

Responsibilities And Duties:

1. 60%
   Assigns appropriate admit, reason for visit, principal and secondary ICD-9, ICD-10 and CPT- 4 diagnoses and/or procedures by reading documentation present in medical record and applying knowledge of correct coding guidelines as appropriate for hospital service and/or patient type while maintaining
   95%
   quality and meeting and maintaining the minimum Coder productivity requirements. Assigns appropriate CPT Modifiers for facility coding to all CPT codes when necessary. Reviews records for diagnoses that meet medical necessity for Diagnostic and surgical procedures performed according to the CMS Local Coverage Determination LC d and/or National Coverage Determination NC d guidelines. Responsible for recognizing when it is necessary to obtain further clarification from physician when documentation is inadequate, ambiguous, or unclear for coding purposes. Responsible for accurate coding and charging of clinic accounts including the assignment of a facility E/M level using the Ohio Health Scorecard for guidance. Responsible for retrieval of documentation to support the coding of accounts that reside in non-HIM department source systems GE Gentricity, Mosaic, etc. . Assists educators and supervisors with reviewing accounts denied by RAC and other governmental payers for appropriate documentation to support original coding. 2.
   20%
   In the event of insufficient, missing or conflicting documentation, assigns transaction codes in HBOC system and follows department policy for follow up and physician query. 3.
   10%
   : Abstracts all data elements necessary to complete UB0 4 and meet hospital-reporting requirements. 4. 5%
   : Verifies demographics, corrects account number, charges and service and identify missing or incorrect forms in each record. 5. 5%
   : Identifies problem cases on the DNFB and forwards to appropriate staff for follow up. The major duties, responsibilities and listed above are not intended to be all-inclusive of the duties, responsibilities and to be performed by employees in this job. Employee is expected to all perform other duties as requested by supervisor.

Minimum Qualifications:

High School or GED (Required)AAPC - American Academy of Professional Coders - AAPC American Academy of Professional Coders, AHIMA - American Health Information Management Association - American Health Information Management Association, RHIA - Registered Health Information Administrator - American Health Information Management Association, RHIT - Registered Health Information Technician - American Health Information Management Association

Additional Job Description:

Completion of a 2 year program and coding Certification from AHIMA or AAPC and/or graduate of a HIM program and Certification as RHIA/RHIT, and demonstrated knowledge of ICD-9, ICD-10 and CPT-4 classification systems, Advanced Anatomy & Physiology, Medical Terminology, ambulatory reimbursement schemes, and CMS Local Coverage Determination (LCD) and/or National Coverage Determination (NCD) guidelines. Demonstrated advanced knowledge and expertise in general surgery coding, including complex surgical procedure, interpretation of operative reports, surgical anatomy, CPT coding guidelines, modifier application, and National Correct Coding Initiative (NCCI) edits. Must possess strong analytical and critical-thinking skills with the ability to independently review, interpret, and accurately code complex general surgery cases, resolve coding discrepancies, and apply appropriate coding guidelines while maintaining compliance and accuracy standards.

Work Shift:

Day

Scheduled Weekly Hours :

40

Department

Physician Coding

Join us!
… if your passion is to work in a caring environment
… if you believe that learning is a life-long process
… if you strive for excellence and want to be among the best in the healthcare industry

Equal Employment Opportunity

OhioHealth is an equal opportunity employer and fully supports and maintains compliance with all state, federal, and local regulations. OhioHealth does not discriminate against associates or applicants because of race, color, genetic information, religion, sex, sexual orientation, gender identity or expression, age, ancestry, national origin, veteran status, military status, pregnancy, disability, marital status, familial status, or other characteristics protected by law. Equal employment is extended to all person in all aspects of the associate-employer relationship including recruitment, hiring, training, promotion, transfer, compensation, discipline, reduction in staff, termination, assignment of benefits, and any other term or condition of employment

Remote Work Disclaimer:

Positions marked as remote are only eligible for work from Ohio.