Outpatient Coding Analyst (Remote) (Resided within Midwest)

University Hospitals; Shaker Heights (OH); Remote; USD 55,000 - 80,000; Full time

Job summary

A leading healthcare provider seeks an Outpatient Coding Analyst to handle pre-bill edits and errors related to coding. This remote position requires expertise in ICD-10 coding, communication skills, and a background in health information management. Ideal candidates will have relevant coding certifications and experience, ensuring compliance with healthcare regulations while mentoring students and providing analytical support.

Qualifications

• 4+ years ICD-10 coding experience, preferably in a large academic medical center.
• Registered Health Information Technologist (RHIT) or Registered Health Information Administration (RHIA) certification required.

Responsibilities

• Reviews claims edits and prepares material for claims denials.
• Assigns appropriate CPT/PCS and ICD10 codes for surgery reservations.
• Maintains coding credentials and knowledge of regulatory guidelines.

Skills

Expertise in surgical/procedure coding

Excellent written and verbal communication skills

Detail-oriented and organized

Client service and relationship building

Education

Associate's Degree in HIM

Bachelor's Degree In HIM

Tools

Microsoft Office Suite

Job description

Job Description - Outpatient Coding Analyst (Remote) (Resided within Midwest) (250003SC)

Outpatient Coding Analyst (Remote) (Resided within Midwest) - ( 250003SC )

A Brief Overview

Responsible for research, management and resolution of pre-bill edits, and pre-bill errors. Conducts and or facilitates any other activities related to regulatory related coding requirements reviews, denials, surgery reservation CPT/PCS code(s) assignment and patient inquiries requiring coding review.

What You Will Do

• Reviews claims edits, from different source systems, via assigned work queues, leveraging coding and regulatory expertise, enabling cases to be successfully processed in a timely and accurate manner.
• Prepares material through research of coding and/or payer guidelines for claims denials. Reviews coding and recommends updated coding changes and/or provides appeal documents to follow up Team.
• Responsible for reviewing assigned surgery reservation forms and assigning appropriate CPT/PCS and ICD10 codes to initiate pre certification process.
• Reviews requests from the Customer Service department related to HIS coding disputes.
• Performs analytic reviews of encounters generated by vendors or other external sources.
• Maintains coding knowledge and skills via written coding resources, clinical information and educational webinars. Maintains credentials. Maintains updated knowledge of regulatory guidelines and regulations affecting the coding field. Maintains knowledge of guidelines and regulations affecting the UHHS Coding Department.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA).
• Trending for potential edits and working with the Coding Educator to develop training and ongoing education based on identified needs.

Additional Responsibilities

• Participates in educational and informational activities.
• Participates in student mentorship programs.
• Performs other duties as assigned.
• Complies with all policies and standards.
• For specific duties and responsibilities, refer to documentation provided by the department during orientation.
• Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace.

Education

• Associate's Degree in HIM (Required)
• Bachelor's Degree In HIM (Preferred)

Work Experience

• 4+ years ICD-10 coding experience, preferably in a large academic medical center. (Required)
• 3+ years with hospital revenue accounting, billing, reimbursement and/or patient accounting (Required)
• Experience in working directly with physicians and others (Preferred)

Knowledge, Skills, & Abilities

• Expertise in surgical/procedure coding. (Required proficiency)
• Thorough, up-to-date clinical skills, current working knowledge of pathology, pharmacology, surgical procedures, etc. (Required proficiency)
• Excellent written and verbal communication skills. (Required proficiency)
• Ability to function independently and as a team player in a fast-paced environment. (Required proficiency)
• Detail-oriented and organized, with good problem solving ability. (Required proficiency)
• Notable client service, communication, and relationship building skills. (Required proficiency)
• Demonstrated ability to use PCs, Microsoft Office suite, and general office equipment (i.e. printers, copy machine, FAX machine, etc.). Proven ability to work within multiple systems. (Required proficiency)

Licenses and Certifications

• Registered Health Information Technologist (RHIT) (Required) or
• Registered Health Information Administration (RHIA) (Required) and
• Certified Coding Specialist (CCS) (Preferred)