Pre-Bill Coder Specialist - Outpatient

Advocate Health; Allenton (WI); Remote; USD 60,000 - 85,000; Full time

Job summary

A leading healthcare provider is seeking a Pre-Bill Coder Specialist to manage coding accuracy for outpatient services. This role demands expertise in coding guidelines (ICD, CPT, HCPCS) and involves collaboration across departments to ensure compliance and reimbursement. Ideal candidates will have significant experience in an acute care setting and the ability to thrive in a fast-paced environment.

Qualifications

• Certification through AHIMA or AAPC required.
• Five to seven years of inpatient coding experience.
• Advanced proficiency in coding guidelines.

Responsibilities

• Code and abstract high dollar charts with accuracy.
• Review complex medical documentation to assign codes.
• Collaborate with departments for documentation issues.

Skills

ICD coding

CPT coding

HCPCS coding

Medical terminology

Communication skills

Analytical skills

Education

Two Year associate degree

Job description

Join to apply for the Pre-Bill Coder Specialist - Outpatient role at Advocate Health

Join to apply for the Pre-Bill Coder Specialist - Outpatient role at Advocate Health

• Prioritizes and codes and abstracts high dollar charts, day after discharge, as well as interim charts, at regular intervals, with a high degree of accuracy.
• Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes utilizing ICD CM/PCS, CPT, and HCPCS.
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Assigns codes for present on admission, research, Hospital acquired Conditions and Core Measure Indicators for all diagnoses both concurrently and post-discharge.
• Collaborates with other departments to clarify pre-bill coding documentation issues such for inpatient and outpatient to insure reimbursement and clinical outcomes.
• Works claim edits for all patient types and may codes consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
• Completes informal peer-review on inpatient and outpatient coders.
• Tracks and trends quality information from internal and external sources to partner with the educational team on opportunities.
• Communicates with Medical Staff, CDI, Post -bill for documentation clarification.
• Utilizes EMR communication tools to track missing documentation on inpatient queries that require follow-up to facilitate coding in a timely fashion. Partners with HIM, Patient Accounts, and Integrity, when needed, to help resolve issues affecting reimbursement and outcomes.
• Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for coding all types of patients.
• Must be able to use critical decision-making skills to determine when to query to clarify documentation independently for outcomes, reimbursement and benchmarking.
  
  

• Prioritizes and codes and abstracts high dollar charts, day after discharge, as well as interim charts, at regular intervals, with a high degree of accuracy.
• Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes utilizing ICD CM/PCS, CPT, and HCPCS.
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software. Assigns codes for present on admission, research, Hospital acquired Conditions and Core Measure Indicators for all diagnoses both concurrently and post-discharge.
• Collaborates with other departments to clarify pre-bill coding documentation issues such for inpatient and outpatient to insure reimbursement and clinical outcomes.
• Works claim edits for all patient types and may codes consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios.
• Completes informal peer-review on inpatient and outpatient coders.
• Tracks and trends quality information from internal and external sources to partner with the educational team on opportunities.
• Communicates with Medical Staff, CDI, Post -bill for documentation clarification.
• Utilizes EMR communication tools to track missing documentation on inpatient queries that require follow-up to facilitate coding in a timely fashion. Partners with HIM, Patient Accounts, and Integrity, when needed, to help resolve issues affecting reimbursement and outcomes.
• Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for coding all types of patients.
• Must be able to use critical decision-making skills to determine when to query to clarify documentation independently for outcomes, reimbursement and benchmarking.
  
  

License/Registration/Certification

• Must have a certification through American Health Information Management Association (AHIMA) or American Academy of professional Coders (AAPC)
  
  

Education

• Two Year associate degree or equivalent work experience
  
  

Experience

• Five to Seven years of inpatient coding experience in an acute care inpatient setting in an Academic Inpatient Care Tertiary Facility
  
  

Knowledge, Skills & Abilities Required

• Advanced profiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
• Excellent communication (oral and written) and interpersonal skills.
• Excellent organization, prioritization, and reading comprehension skills.
• Excellent analytical skills, with a high attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.
  
  

Physical Requirements And Working Conditions

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able tocontinuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.
• This job description indicates the general nature and level of work expected of the incumbent. It is not designed
• to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.
  
  

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

#REMOTE

Seniority level

• Seniority level

  Mid-Senior level

Employment type

• Employment type

  Full-time

Job function

• Job function

  Health Care Provider

• Industries

  Hospitals and Health Care

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