Outpatient Certified Coder - Health Information Management

DaMar Staffing; Ventura (CA); On-site; USD 75,000 - 110,000; Full time

Benefits offered by this job

Educational Incentive

Bilingual Incentive

Merit Increases

Deferred Compensation

Health Plans

Flexible Spending Accounts

Pension Plan

Holidays

Additional Benefits

Job summary

Health Care Agency in Ventura County seeks a Coder-Certified to perform outpatient facility and physician professional coding across hospital and ambulatory care settings. You will review medical documentation, assign ICD-10-CM/PCS, CPT, and HCPCS codes, and ensure accurate reimbursement under PPS, DRG, and APC methodologies.

Ideal candidates have knowledge of E/M coding and related guidelines, and strong analytical, organizational, and communication skills.

Qualifications

• Two (2) years of recent experience in acute care coding using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS and/or DRG assignments.
• AAHIMA/AAPC certifications required or preferred; knowledge of payer guidelines and coding compliance.

Responsibilities

• Code and abstract outpatient medical records and physician professional fees using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS and DRG.
• Review medical documentation for completeness and accuracy per guidelines.
• Query physicians for clarification to assign or validate codes.
• Provide education on billing guidelines and assist in audits and charge capture.

Skills

Attention to detail

Regulatory compliance

Communication skills

Team collaboration

Education

AHIMA CCS

RHIA/RHIT

AAPC CPC

Tools

ICD-10-CM

ICD-10-PCS

CPT

HCPCS

Job description

Coder-Certified

The Health Care Agency is a comprehensive healthcare system serving our diverse community of Ventura County through Ventura County Medical Center (VCMC), Santa Paula Hospital, primary and specialty care clinics, Ambulatory Care, Public Health, and Behavioral Health. Join our team and use your coding expertise to support accurate documentation, appropriate reimbursement, regulatory compliance, and quality patient care. Are you a detail-oriented coding professional who takes pride in accuracy and continuous learning? The Health Care Agency is seeking a Coder-Certified to perform outpatient facility and physician professional fee (Pro-Fee) coding across hospital and ambulatory care settings. Under general direction, the Coder-Certified reviews and analyzes medical documentation, assigns appropriate diagnosis and procedure codes, applies coding and billing guidelines, and collaborates with physicians and other healthcare professionals to support accurate and compliant coding.

The ideal candidate has specialized knowledge of ICD-10-CM, ICD-10-PCS, CPT, HCPCS, E/M coding, outpatient surgery coding and applicable reimbursement methodologies including PPS, DRG, and APC along with strong analytical, organizational, and communication skills. This position offers an opportunity to work across a variety of outpatient services and specialties while contributing to accurate documentation, appropriate reimbursement, and quality patient care. This classification is unique in that it requires specialized knowledge and certificates relating to medical coding of records. Training/assignment assessments may be conducted to determine candidates' current skills and identify growth opportunities.

The County of Ventura offers an attractive compensation and benefits package. Aside from our base salary range, an employee in this position may also be eligible for the following:

• Educational Incentive - Some positions may be eligible for educational incentive. This incentive may be 2.5%, 3.5%, or 5% for incumbents in eligible positions based on completion of an Associate's, Bachelor's, or Master's degree that is not required for the classification.
• Bilingual Incentive - Some positions may be eligible for bilingual incentive depending on the applicable memorandum of agreement and the needs of the department. In order to qualify for this incentive, incumbents in eligible positions must take and pass the applicable bilingual fluency exam with a score of seventy percent (70%) or higher. Proficiency levels by exam are $0.69/hour (Level I), $1.00/hour (Level II), or $1.32/hour (Level III).
• Merit Increases - New employees serving their initial County service probationary period are eligible for an initial 5% merit increase upon completion of at least 1,040 hours (approximately six months) assuming work meets satisfactory standards. Subsequent merit increases will be upon completion of each additional 2,080 hours (approximately one year) from the initial merit increase.
• Deferred Compensation - Eligible to participate in the County's 401(K) Shared Savings Plan and/or the Section 457 Plan. If you participate in the County sponsored 401(K) plan, the County will match a part of your contribution up to 3% of your salary, on a per pay period basis.
• Health Plans - You are afforded a flexible credit allowance for purchasing medical plan under the County's Flexible Benefits Program. County now pays 100% of dental and vision premiums.
• Flexible Spending Accounts - Pre-tax benefit towards eligible medical, dental, and vision care expenses.
• Pension Plan - Participate in the County's defined benefit pension plan that provides lifetime payments to retirees. Members are "vested" after attaining five years of retirement service credit. If eligible, you may establish reciprocity with other public retirement systems such as CalPERS.
• Holidays - 13 paid days per year which includes a scheduled floating holiday.
• Additional Benefits - Tuition Reimbursement, Disability Plans, Employee Assistance Program, Life Insurance, Wellness Program.

Duties may include but are not limited to the following:

• Codes and abstracts, and reviews discharged outpatient medical records and physician professional services for a multi-specialty teaching facility using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); International Classification of Diseases, Tenth Revision, Clinical Modification and Procedure Coding System (ICD-10-PCS); Current Procedural Terminology (CPT); Health care Common Procedure Coding System (HCPCS); Prospective Payment System (PPS); and/or Diagnosis-Related Group (DRG) assignments based on Prospective Payment System (PPS) and/or Ambulatory Payment Classification (APC) methodologies; including Evaluation and Management codes (E/M), procedure codes, modifiers, National and Local Correct Coding Initiatives (NCCI) edits;
• Examines and analyzes provider documentation and medical charts for completeness, accuracy, and relevancy in accordance with Federal and State regulations, ICD-10-CM Official Coding Guidelines and American Medical Association (AMA) guidelines;
• Identifies the need for additional clinical documentation and sends queries to physicians for clarification on diagnoses and procedures performed to assign and/or validate the diagnosis or procedure code(s);
• Conducts provider training and on-going education on billing guidelines and audits the work of non-facility coders;
• Assists the Clinical Documentation Improvement (CDI) team with education CPT/HCPCS codes, billing guidelines and charge capture Outpatient ancillary department clinical staff;
• Inputs completed patient data coding classification systems into the hospital's Information Management System in accordance with The Joint Commission (TJC) and the Corporate Integrity Agreement between VCMC and the Office of the Inspector General;
• May process fee-for-service physician claims and audit physician billing for contract compliance;
• Identifies coding trends or issues and assists in resolving them;
• Ensures codes meet payer-specific requirements and resolves denials; and
• Performs other related duties as assigned.

These are entrance requirements to the examination process and ensure neither continuance in the process nor placement on an eligible list. EDUCATION, TRAINING, and EXPERIENCE: Two (2) years of recent experience in an acute care setting using ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS and/or DRG assignments. NECESSARY SPECIAL REQUIREMENTS: Must have experience performing outpatient hospital and physician professional (Pro-Fee) coding.

For Hospital Coding - Must possess one or more of the following certifications, certified by the American Health Information Management Association (AHIMA): Certified Coding Specialist (CCS), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Associate (CCA), Certified Professional Coder (CPC) as credentialed by the American Academy of Professional Coders (AAPC)

For Physician Professional Coding - Must possess one or more of the following certifications, certified by the American Health Information Management Association (AHIMA): Certified Coding Specialist (CCS), Certified Coding Specialist-Physician (CCS-P), Certified Professional Coder (CPC) as credentialed by the American Academy of Professional Coders (AAPC)

Thorough knowledge of: ICD-10-CM, ICD-10-PCS, CPT, HCPCS, PPS, DRG and APC systems; E/M and procedure codes, modifiers, and NCCI edits; anatomy, physiology, disease pathology, and medical terminology necessary to correctly code diagnoses, procedures, and services; and Pro-Fee coding

Working knowledge of: The Joint Commission standards for Medical Records Management and Clinical Documentation Programs

Working Ability to: Code and abstract outpatient medical records and/or physician professional fees using ICD-10-CM, CPT, HCPCS, and applicable coding and reimbursement methodologies (such as PPS/APC).

Ability to: Communicate with all levels of professionals, including physicians; Train and educate providers on professional coding.

Working Conditions: Duties are performed primarily in an indoor hospital environment with heavy personnel and public contact. Tasks involve both sedentary and moderate activities.