Coder - Outpatient

Rochester Regional Health; City of Rochester (NY); On-site; USD 29,000 - 39,000; Full time

Job summary

Rochester General Hospital is seeking a Remote Outpatient Coder to review clinical documentation and assign ICD-10-CM and ICD-10-PCS codes for billing, reporting, and regulatory compliance. You will work with Care Connect, UDS, and Clintegrity to ensure accurate DRG assignments and resolve billing errors.

The ideal candidate holds AHIMA credentials or equivalents and has 2+ years of hospital or multi-specialty coding experience, with a pathway to CPC cert if applicable.

Qualifications

• AS Health Information Management required.
• 2+ years progressive coding experience preferred.
• Full CPC certification must be obtained within 24 months if CPC-A at hire.
• Homecare: HCS-D certification required within 16 months of hire.
• Grandfather clause: if hired on/before 2018-09-30, etc.

Responsibilities

• Review documentation to assign ICD-10-CM and ICD-10-PCS codes.
• Meet productivity guidelines with 95% accuracy.
• Utilize Care Connect, UDS, Clintegrity to obtain codes and DRG assignments.
• Formulate physician coding queries when documentation is inadequate or unclear.
• Correct failed claim errors and assist in resolving billing issues.
• Assist physicians and clinical staff with coding reimbursement opportunities and quality reviews.

Education

AS Health Information Management

CPC-A

RHIT

RHIA

CCS

CCS-P

CPC

CPC-H

CMC

HCS-D

Tools

Care Connect

UDS

Clintegrity

Job description

JOB TITLE: Coder - Outpatient - Riedman - Remote, Coding/Clinical Documentation (Full-Time, Days)STATUS: Full-TimeLOCATION: Riedman- RemoteDEPARTMENT: Coding/Clinical DocumentationSCHEDULE: M-F; DaysSUMMARYReview clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for billing, internal and external reporting, research, and regulatory compliance. Demonstrate knowledge of reimbursement methodologies and apply these to assigned charts to optimize reimbursement and/or resolve regulatory edits. Resolve error reports associated with the billing process, identify and report error patterns, and, when necessary, assist in the design and implementation of workflow changes to reduce billing errorsRESPONSIBILITIESAbides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines, and keeps abreast of coding changes and interpretation of codes.Performs detailed review of Inpatient record documentation to identify & assign diagnosis & procedure codes using ICD-10-CM and ICD-10-PCS.Meets established departmental productivity guidelines with 95% accuracy on a consistent basis.Utilizes Care Connect, UDS, and Clintegrity systems proficiently to obtain ICD10 codes and DRG assignment.Formulates compliant Physician Coding Queries when documentation is inadequate, ambiguous, or unclear for coding purposes.Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.Provide assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.MINIMUM QUALIFICATIONSOne of the following certifications is required: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder Apprentice CPC-A, or a specialty coding certification.Candidates with an Associate degree from an accredited American Health Information Management Association (AHIMA) are required to sit for the Registered Health Information Technician (RHIT) exam within 1 year of hire.At least 2 years of progressive coding experience in a hospital or multi-specialty physician practice setting preferred.Full CPC certification must be obtained within 24 months if employee holds CPC-A from the American Academy of Professional Coders (AAPC) at time of hire.For HOMECARE: Homecare Diagnosis Coding Specialist (HCS-D) certification required within 16 months of hire.Grandfather Clause: If hired on or before September 30, 2018, 2 years of relevant work experience and one of the following coding certification credentials: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS-P), Certified Professional Coder (CPC), Certified Professional Coder - Hospital Based (CPC-H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or a specialty coding certification and Associate’s degree in Health Information Management are required.EDUCATION:AS: Health Information Management (Required)LICENSES / CERTIFICATIONS:PHYSICAL REQUIREMENTS:Sedentary - Sedentary roles are primarily office-based and require prolonged sitting (67–100% of the workday) with minimal physical effort and lifting limited to under 10 lbs. Fine motor skills are necessary for computer work, writing, and telephone use, supported by clear visual and auditory ability. Cognitive and emotional demands are high due to extended concentration, frequent interruptions, independent decision-making, and information processing. Although physical exposure is low, administrative areas within healthcare environments may occasionally involve contact with infectious agents. Some roles may require flexible hours, TB screening, or a valid driver’s license.For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.Any physical requirements reported by a prospective employee and/or employee’s physician or delegate will be considered for accommodations.PAY RANGE:$20.75 - $28.50CITY:RochesterPOSTAL CODE:14617The listed base pay range is a good faith representation of current potential base pay for a successful full time applicant. It may be modified in the future and eligible for additional pay components. Pay is determined by factors including experience, relevant qualifications, specialty, internal equity, location, and contracts.Rochester Regional Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex (including pregnancy, childbirth, and related medical conditions), sexual orientation, gender identity or expression, national origin, age, disability, predisposing genetic characteristics, marital or familial status, military or veteran status, citizenship or immigration status, or any other characteristic protected by federal, state, or local law.