Coding Specialist Outpatient Telecommute-Surgical Coder

Lifespan; Providence (RI); On-site; USD 33,062 - 55,104; Full time

Job summary

Brown University Health is seeking a skilled Health Information Specialist focused on outpatient coding. You will review clinical documentation, assign ICD-10-CM and CPT codes, and ensure documentation supports code assignments with 3M 360 Finder.

Collaboration with physicians for clarification and adherence to guidelines is essential. The role requires familiarity with NCCI edits, medical necessity standards, and timely resolution of uncoded reports.

Qualifications

• High school diploma or equivalent; formal coding education; ability to read outpatient records for reporting of outpatient clinic, ancillary and endoscopies; coding certification from AHIMA or AAPC.

Responsibilities

• Enter coded/abstracted information into 3M 360 Finder and review coding edits.
• Follow NCCI and relevant medical necessity requirements.
• Resolve accounts on the claims edit database and assign codes to clinic visits.

Skills

Medical coding

Documentation review

Education

High School Diploma

AHIMA or AAPC certification

Tools

3M 360 Finder

Job description

Summary

Reports to the Coding Manager. Reviews the outpatient clinical documentation of extract data and assigns appropriate ICD-10-CM and CPT codes in accordance with the outpatient ICD-10-CM Official Guidelines for Coding and Reporting and the AHA HCPCS Coding Clinics. Reviews the medical records to ensure the documentation supports the code assignment. Utilizes 3M 360 Finder for code assignment and appropriate resolutions of claim edits (CCI, NCD, OCE, etc.) Confer with physician for clarification as needed. Monitors outpatient uncoded report to ensure timely coding and billing process. Maintains and meets HIS quality and productivity standards. Brown University Health employees are expected to successfully role model the organization’s values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include: Instill Trust and Value Differences; Patient and Community Focus and Collaborate.

Responsibilities

• Enters codedbstracted information into 3M 360 Finder, assigning accurate APC and reviewing all coding edits appearing in 3M.
• Understands and follows all National Correct Code Initiative Edits (NCCI) and follows pertinent medical necessity requirements.
• Resolves accounts on the claims edit database.
• Assigns injections and infusion codes for observation patients.
• Meets the minimum productivity standard by maintaining an average accuracy rating of 95%.
• Assigns E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits ensuring medical record documentation supports the code.
• If physicians have entered diagnosis, ICD or CPT codes, ensures they are accurate and supported by documentation in the medical record.
• Utilizes 3M to identify and resolve NCCI edits before final billing.
• Reports documentation insufficiencies to the responsible physician.
• Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients less than 18 years of age.
• Monitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports within established timeframe, researching coding conflicts including chargemaster, medical necessity, and various other coding and billing issues.
• Refers complex coding issues to the coding validator or supervisor.
• Reviews pertinent outpatient uncoded reports, researching and resolving old uncoded accounts and any accounts posted on report for which the charges are inappropriate.
• Updates patient financial accounts in the Patient Management and Patient Accounting billing system as required.
• Follows established procedures for rebilling accounts.
• Performs related clerical duties as required.
• Maintains level of knowledge and expertise pertinent to the position.

Minimum Qualifications

• Basic Knowledge: High school diploma or equivalent; successful completion of formal coding educational program; ability to read and understand outpatient clinic medical record documentation for reporting of outpatient clinic, ancillary and endoscopies; coding certification required from AHIMA or AAPC.
• Experience: One to two years experience in outpatient coding or billing; ability to meet and maintain established quality and productivity standards.

Working Conditions

Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, and use step‑stools to file records. Ability to work under stressful conditions to maintain accounts receivable days and achieve productivity and accuracy.

Independent Action

Performs independently within the department's policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

Supervisory Responsibility

None.

Pay Range

$24.29 - $40.07 per hour.

Employment Information

Location: Corporate Headquarters - 15 LaSalle Square, Providence, Rhode Island 02903

Work Type: 8:00am-4:30pm

Work Shift: Day

Daily Hours: 8 hours

Driving Required: No

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.