Specialist Inpatient Coder

Orlando Health; Orlando (FL); On-site; USD 60,000 - 80,000; Full time

Job summary

Orlando Health, Inc. is seeking a Coding Specialist to review and assign ICD-10-CM and CPT-4 codes for multifacility Same Day Surgery and Outpatient Observation visits using EPIC EMR, encoder, and CAC tools.

Responsibilities include sequencing codes for APC assignment, ensuring medical necessity, and querying physicians for documentation clarity while collaborating with revenue management teams to meet departmental goals with a target 95% accuracy.

Qualifications

• Bachelor's or Associate degree or coding certificate program.
• Medical terminology and anatomy/physiology knowledge required.
• Score 90% or better on Orlando Health level II coding skills test.
• Must maintain CCS/CCA/CPC/COC/RHIA/RHIT certifications as applicable.

Responsibilities

• Review and assign ICD-10-CM/CPT-4 codes for ambulatory visits.
• Sequence diagnoses and CPT-4 codes for APC assignment.
• Communicate with physicians and healthcare staff effectively.
• Ensure medical necessity by complete documentation review.
• Resolve coding validation checks and apply modifiers when needed.

Skills

ICD-10-CM coding

CPT-4 coding

Verbal communication

Team collaboration

Attention to detail

Education

Bachelor's or Associate degree

Coding certificate program

Medical terminology knowledge

Anatomy & physiology knowledge

Tools

EPIC EMR

Encoder

CAC

Job description

Coding Specialist

Responsibilities

• Perform review and analysis of clinical documentation and accurately assign diagnosis and procedure codes for multifacility Same Day Surgery and Outpatient Observation visits using ICD-10-CM and/or CPT-4 classification systems, utilizing EPIC Electronic Medical Record (EMR), encoder, computer assisted coding (CAC), and other applications as applicable.
• Appropriately sequence diagnoses/status codes and HCPCS Level 1 and Level II CPT-4 procedure codes for proper Ambulatory Classification (APC) assignment, utilizing applicable coding conventions, Official Guidelines on Coding and Reporting, and Center for Medicare and Medicaid Services (CMS) guidelines.
• Communicates cooperatively and constructively with physicians, physicians' office personnel, guests, patients, and members of the healthcare team. Demonstrates good verbal communication skills.
• Ensure procedure medical necessity coverage, when possible, by complete review of provider documentation and accurate ICD-10-CM code assignment.
• Accurately assign modifiers to CPT-4 procedures as applicable.
• Accurately clear all applicable NCCI edits and coding validation check errors/warnings at the time of coding.
• Accurately abstracts information into hospital information system.
• Request additional documentation, as needed, to ensure complete accurate code assignment.
• Query physicians for clarification of documentation discrepancies and inconsistencies.
• Effectively collaborate with other revenue management departments for resolution of account errors or anomalies.
• Works with coding teams to ensure completion of all coding within corporate goals.
• Provides data for reports on statistics, optimization, productivity, etc.
• Maintains 95% accuracy and participates in department QA studies.
• Maintains level of productivity established by department.
• Cross trains in all aspects in coding based on department need.
• Attends departmental and other meetings as requested.
• Completes and actively participates in education activities as assigned by OH Hospital Coding Leadership.
• Demonstrates knowledge and understanding of coding guidelines, procedures, medical necessity/CCI edits and the APC reimbursement system and keeps abreast of current coding changes and standards of care to maintain.
• Complies with the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), American Academy of Professional Coders (AAPC), and adheres to official guidelines.
• Assures confidentiality of patient information.
• Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
• Maintains compliance with all Orlando Health policies and procedures.

Other Related Functions

• Maintains established work production standards.
• Works as a team member to meet department goals.
• Assumes the responsibility for professional growth and development through education programs, research, etc.

Qualifications

• Education/ Training: Bachelor's or Associates degree; OR coding certificate program and computer literacy required and medical terminology, anatomy and physiology required and demonstrated knowledge of coding complex outpatient surgical procedures and score 90% or better on Orlando Health level II coding skills test.
• Licensure/Certification: Must maintain one of the following: Certified Coding Specialist (CCS) Coding Associate (CCA) by the American Information Management Association (AHIMA) – renewed every 2 years Certified Professional Coder (CPC) by the American Academy of Professional Coders (AAPC) – renewed every 2 years. Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) – renewed every 2 years. Registered Health Information Administrator (RHIA) – preferred but not required Registered Health Information Technician (RHIT) – preferred but not required.
• Experience: 2 years previous hospital coding experience required. Thorough knowledge of coding classification systems required.