Outpatient Certified Coder

Care New England; Warwick, Northern (RI, KY); On-site; USD 60,000 - 80,000; Full time

Job summary

Care New England seeks a Certified Outpatient Coder to ensure accurate ICD-10-CM, CPT and HCPCS coding across outpatient services. You will apply coding guidelines to maintain compliant records for observation, surgery, ER, oncology and other services, while adhering to CMS, AHA and AMA standards.

Responsibilities include analyzing records, assigning codes, and ensuring data integrity for reimbursement, reporting, and care planning.

Qualifications

• Three years hospital experience within the last five years.
• CCS or CPC certification preferred or will be considered with additional experience.
• Classes in medical terminology, anatomy & physiology, ICD-10-CM and CPT coding conventions; certification maintained.

Responsibilities

• Analyze medical records and assign ICD-10-CM, CPT and HCPCS codes per guidelines.
• Code diagnostic and operative information using ICD-10-CM/ICD-10-PCS, CPT, HCPCS; perform quality checks.
• Ensure data abstracted aligns with CMS, JCAHO, regional and local policy.
• Review records to determine required abstracting elements and discharge disposition for reimbursement.
• Adhere to AHIMA code of ethics and maintain productivity/accuracy standards.

Skills

ICD-10-CM coding

CPT/HCPCS coding

Auditing skills

Regulatory compliance knowledge

Education

Associate's degree preferred

High School or GED required

Job description

Job Summary

The role of a Certified Outpatient Coder at Care New England is to ensure accurate assignment of ICD-10 CM, CPT and HCPCS codes on a wide range of patient medical records for outpatient services. Outpatient services include, but are not limited to observation, surgical, provider-based visits, interventional radiology, emergency room, oncology, and other specialty services. A proficient understanding and execution of coding guidelines to ensure accuracy of coding and maintain records in accordance with accepted medical and legal standards.

Adherence and compliance to various regulatory guidelines from CMS, AHA and AMA.

Duties & Responsibilities

• Analyze medical records, extracting clinical, pathological, therapeutic and epidemiologic data in accordance with established ICD-10-CM coding principles and guidelines
• Assigns Codes and codes all diagnostic and operative information from the medical record using ICD-10-CM/ICD-10-CM, ICD-10 PCS, CPT, HCPCS coding classification systems and independently quality checks own work
• Assigning ICD-10 diagnosis codes, CPT validation, modifier assignment
• Ensures that all data abstracted is consistent with guidelines outlined by JCAHO, and CMS, regional and local policy
• Evaluating, addressing and understanding CCI, LCD and NCD edits
• Ensure data is optimally coded for documentation capture, financial reimbursement, care planning, statistics and regulatory reporting
• Reviews medical records to determine accurate required abstracting elements (facility/client specific elements) including appropriate discharge disposition to ensure accurate reimbursement
• Demonstrates a comprehensive, expert-level of knowledge of all procedures concerning the sequencing of diagnoses, procedures such as but not limited to those outlined in ICD-10-CM, CPT, Uniform Hospital Discharge Data Set, Medicare guidelines and other appropriate classification systems
• Demonstrates knowledge of anatomy, physiology pharmacology and pathophysiology to interpret general medical classifications for coding discharge data.
• Ensures timely record availability by meeting established coding and abstracting CNE productivity and accuracy standards
• Communicates and resolves coding issues around documentation for appropriate follow-up and education
• Interacts and communicates with department lead and manager to clarify and accurately document patient diagnostic and procedural information
• Maintains and complies with policies and procedures for confidentiality of all patient records
• Performs other related duties as assigned

Requirements

• High School or GED Required; Associate's Degree Preferred
• Must have at least three (3) years hospital experience within the last five years
• This position has a preferred certification as a Certified Coding Specialist (CCS). A Certified Professional Coding certification will also be considered with additional years of experience.
• Completion of classes in medical terminology, anatomy and physiology, ICD-10 and CPT coding conventions, and disease process from an accredited program. Coding certification must be maintained.
• Ability to demonstrate knowledge of and utilize auditing skills related to coding quality and compliance.
• Ability to understand the clinical content of a health record, including the most complicated records.
• Must also be able to communicate with others in order to clarify diagnoses/procedures and sequencing of diagnoses.
• Strong attention to detail and accuracy is necessary. Will abide by the AHIMA coding code of ethics.
• Must be able to maintain department productivity and accuracy standards.

About Us

Care New England Health System (CNE) and its member institutions, Butler Hospital, Women & Infants Hospital, Kent Hospital, VNA of Care New England, Integra, The Providence Center, and Care New England Medical Group, is a trusted, integrated health care organization that fuels the latest advances in medical research, attracts the nation’s top specialty-trained doctors, hones renowned services and innovative programs, and engages in the important discussions people need to have about their health and end-of-life wishes. Care New England is helping to transform the future of health care, providing a leading voice in the ongoing effort to ensure the health of the individuals and communities we serve.

EEO Statements

Americans with Disability Act Statement: External and internal applicants, as well as position incumbents who become disabled must be able to perform the essential job-specific functions either unaided or with the assistance of a reasonable accommodation, to be determined by the organization on a case-by-case basis.

EEOC Statement: Care New England is an equal opportunity employer. All applicants will be considered for employment without attention to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran or disability status

Ethics Statement: Employee conducts himself/herself consistent with the ethical standards of the organization including, but not limited to hospital policy, mission, vision, and values.