Coder III Outpatient

Avera Health; United States; On-site; USD 35,000 - 52,000; Full time

Benefits offered by this job

PTO from day 1

5% retirement match

Mentorship program

Job summary

Avera Health in Sioux Falls, SD, seeks a Coder III to assign outpatient diagnostic and procedural codes across multiple facilities, focusing on complex and high-dollar cases. You will perform accurate abstracting and support denials management while educating junior coders.

The role requires expertise in ICD-10-CM, CPT, HCPCS, and collaboration with clinicians to ensure proper capture of services. This on-site position offers a competitive hourly pay range and comprehensive benefits.

Qualifications

• Certified Coding Specialist (CCS) within 180 Days
• RHIA within 180 Days
• RHIT within 180 Days
• CCS-P within 180 Days

Responsibilities

• Review patient documentation to identify ICD-10-CM, CPT, HCPCS codes across facilities.
• Determine APC/EAPC and medical coding for outpatient types including surgeries, observations, injections.
• Master most outpatient types and code accordingly.
• Serve as expert for coding topics and educate others as needed.
• Query clinicians to ensure complete capture of the clinical record.
• Assist with denials management and medical necessity appeals.
• Lead communication between HIM, billing and providers as needed.
• Maintain quality and production statistics per standards.

Education

Certified Coding Specialist (CCS)

Registered Health Information Administrator (RHIA)

Registered Health Information Technician (RHIT)

Certified Coding Specialist - Physician-based (CCS-P)

Job description

Location:

Avera Downtown Building-Sioux Falls

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

The pay range for this position is listed below. Actual pay rate dependent upon experience.

$25.50 - $38.00

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

A Brief Overview

Responsible for the timely and accurate assignment of diagnostic and procedural codes for most types of outpatient charts for multiple facilities within Avera Health, with a focus on the more complex and high-dollar cases. Accurate abstracting along with other reporting and editing function is also a major responsibility. The Coder III works independently to meet quality and production goals for the position. Varied amounts of time will be spent educating Coder I, III and III coders along with helping others with denials management.

What you will do

• Review all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM, CPT, and HCPCS diagnosis and procedure codes for assigned patient charts across Avera's facilities. Understand ICD-10-CM, CPT and HCPC codes in depth, and be willing to update that knowledge through research or other educational opportunities.
• Focus on determining the appropriate APC/EAPC and/or appropriate medical coding for a variety of outpatient patient types including, but not limited to, surgeries, observation, injections/infusions, and/or oncology.
• Expected to have a mastery of the majority of all outpatient types in the outpatient service line and code those as needed.
• Serve as a subject matter expert for other health professionals within Avera on coding related topics.
• Queries physicians and clinical documentation staff to ensure a full capture of the clinical record.
• Assist staff with denials management, including the processing of edits, serving as a subject matter expert, or helping to provide input for medical necessity and other related appeals using appropriate coding guideline references.
• Lead communication between health information management, billing, and providers as needed.
• Maintains personal quality and production statistics in accordance to service line standards for a Coder I. Adheres to ethical standards regarding coding as set by Avera Health.

Essential Qualifications

The individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.

Required Education, License/Certification, or Work Experience:

• Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days or
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) within 180 Days or
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days

Preferred Education, License/Certification, or Work Experience:

• Associate's Health Information Administration or Health Information Technology
• 4-6 years of coding experience

Expectations and Standards

• Commitment to the daily application of Avera's mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera's values of compassion, hospitality, and stewardship.
• Uphold Avera's standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].