Outpatient Coding Specialist Iii (Remote)

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Day - 08 Hour (United States of America)

This is a Stanford Health Care job.
A Brief Overview
Advanced coding position that reviews clinical documentation and diagnostic results as appropriate to extract data and assign the appropriate International Classification of Diseases (ICD-10-CM/PCS), CPT codes with modifiers, as well as grouping of Ambulatory Payment Classifications (APCs) for billing, internal and external reporting, research and regulatory compliance. This position codes all types of outpatient records (for example, diagnostic, therapeutic, emergency department services, ambulatory surgery/same day surgery and observation service encounters) and follows the Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of Ethical Coding, as well as all American Hospital Association (AHA) Coding Clinics for HCPCS and the AMA CPT Assistant. This position serves as an expert on outpatient coding, interacting with other departments such as Patient Financial Services or Compliance on a routine basis and additionally may be required to summarize findings for educational purposes upon working through coding edits. Follows Stanford Health Care policies and procedures and maintains required quality and productivity standards. Reviews, abstracts and assigns technical and ethical ICD-10-CM/PCS and CPT codes with modifiers to outpatient services. Ensures compliance with third party, State and Federal regulations. Reviews, analyzes and abstracts physician/other documentation for diagnoses, procedures and other services provided. Obtains missing information and/or clarifies existing information. Completes volume of work from work queues per departmental productivity standards. Groups codes and completed product appropriately. Analyzes information for optimal and proper reimbursement. Ensures compliance with all appropriate coding, billing and data collection regulations and procedures. Uses appropriate software to validate information. Utilizes Epic, 3M Coding and Reimbursement System (Encoder), 3M CDIS, 3M Audit Expert, MS Office, and other software as appropriate to compile and validate medical information. Responsible for validating and working any medical necessity edits that apply in the coding of the outpatient accounts, any error reports associated with revenue cycle process, for identifying and reporting error patterns, and, when necessary, assisting in design and implementation of workflow changes to reduce billing errors.
Locations
Stanford Health Care
What you will do

• Responsible to ensure accuracy and maintain established quality and productivity standards.
• Responsible for monitoring Discharged Not Billed accounts, and as a team, ensure timely, compliant processing of inpatient accounts through the revenue cycle.
• Correctly abstract required data per facility specifications.
• Following established conventions and guidelines, codes and abstracts the medical records of day surgery and outpatient records. Assists with coding and leveling ERs as needed. Assists with coding and charging infusion cases as needed. Keeps work queues within established date goals.
• Critical thinking, good judgment and decision making skills.
• Excellent written and oral communication skills.
• Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision. Exhibits strong time management, problem solving and communication skills.
• Codes procedures as appropriate and identifies the principal procedure consistent with established coding guidelines.
• Remain abreast of current Centers for Medicare and Medicaid Services, (CMS) requirements as well as Correct Coding Initiative, (CCI) edits, Hospital Acquired Conditions, (HAC's), Patient Safety Indicators, (PSI’s), and when applicable, National Coverage Determinations, (NCDs) and Local Coverage Determinations, (LCDs,) including the addition of appropriate modifiers to ensure a clean claim the first time through.
• Collaborates with Clinical Documentation Specialists, (CDSs,) and members of the medical staff to ensure completeness of documentation in the medical records so that appropriate codes, and ultimately the correct Diagnosis Related Group (DRG,) may be assigned.
• Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth.
• Maintains competency and accuracy while utilizing tools of the trade, such as the 3M encoder, 3M Audit Expert process, (3M AES,) 3M Clinical Documentation Improvement System, (3M CDIS,) and abstracting systems, and all reference materials.
• Applies charge data as appropriate for services provided.
• Reviews medical record documentation and accurately assigns appropriate ICD-10 diagnoses and procedure codes, CPT codes and modifiers as applicable, leading to the assignment of the correct Ambulatory Payment Classification (APC). The Inpatient Coding Specialist III is responsible for validating and working any medical necessity edits that are apply in the coding of the outpatient account. Additionally responsible for verification of the patient’s discharge disposition and correct source of admission for state reporting purposes.
• Validates outpatient accounts for medical necessity based on local coverage determination policies (LCDs) or national coverage determinations (NCDs).
• Follows all established Stanford Health Care policies and procedures.

Education Qualifications

• High School Diploma or GED equivalent

Experience Qualifications

• Five (5) years, must be able to code all outpatient types

Required Knowledge, Skills and Abilities

• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities
• Ability to foster effective working relationships and build consensus
• Ability to utilize the ICD-10-CM/PCS and CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record documentation; assign accurate codes for grouping of MS-DRG’s and APR-DRG’s
• Ability to adapt to and deal with change and ambiguity
• Ability to establish and maintain effective working relationships
• Knowledge of computer systems and software used in functional area
• Ability to work effectively with individuals at all levels of the organization
• Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and study of diseases
• Knowledge of diagnosis/procedure DRG grouping schemes such as MS-DRGs and APR-DRGs
• Ability to comply with the American Health Information Management Association’s Code of Ethics and Standards and apply Uniform Hospital Discharge Data Set (UHDDS) standards
• Knowledge of health information systems for computer application to medical records
• Successful completion of the Coder Proficiency Exam (pre-hire)
• Knowledge of CCI (Correct Coding Initiatives) and CMS compliance issues
• Ability to solve technical and non-technical problems
• Ability to plan, organize, prioritize, work independently and meet deadlines
• Ability to work effectively through and with others

Licenses and Certifications

• CCS - Certified Coding Specialist or
• RHIA - Registered Health Information Administrator or
• CPC and/or CCSP - Certified Professional Coder
• RHIT - Registered Health Information Technician or

These principles apply to ALL employees:
SHC Commitment to Providing an Exceptional Patient & Family Experience
Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.
You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care
• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health
• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

Base Pay Scale: Generally starting at $52.76 - $59.42 per hour

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.