Coder III Complex Outpatient Observation / Ambulatory Surgery (REMOTE)

Overview

Coder III Complex Outpatient Observation / Ambulatory Surgery (REMOTE)

Provides high-level technical competency and subject matter expertise analyzing physician / provider documentation contained in Complex Outpatient (CO) and Ambulatory Surgery health records to determine the principal diagnosis, secondary diagnoses, principal procedure, and secondary procedures. Assigns appropriate Ambulatory Procedure Classification (APC) codes, required modifiers, NCCI and LCD / NCD edits.

Employment Type : Full time. Shift : Day Shift.

Responsibilities

• Navigates the patient health record and other computer systems to accurately determine diagnosis and procedures codes, APCs, CPT / HCPCS codes, modifiers, internal edits and claim edits that could impact hospital reimbursement.
• Utilizes encoder software applications and online references to assign ICD-CM diagnosis and procedure codes and CPT / HCPCS procedure codes; uses coding abstracting system edit features to resolve edits prior to completing coding.
• Interprets, researches, and resolves claim edits that occur after coding to support timely final claims submission.
• Interprets bundling and unbundling guidelines (NCCI edits) as well as LCDs / NCDs edits and payer policies.
• Works with Outpatient internal and external claim edits and routes non-coding edits to appropriate owners (e.g., Revenue Integrity, Billing).
• Maintains knowledge of current outpatient coding and reimbursement guidelines and regulations, including new modifiers and wound care.
• Demonstrates knowledge of current, compliant coder query practices when consulting with physicians, Clinical Documentation Specialists (CDS), or other healthcare providers for additional information or to clarify documentation.
• Uses EMR communication tools to track missing documentation or outpatient queries requiring follow-up to facilitate timely coding.
• Collaborates with HIM and Patient Business Services (PBS) teams to resolve billing, denial, and appeal issues affecting reimbursement.
• Maintains CEUs as appropriate for coding credentials and keeps current with changes in outpatient coding and reimbursement guidelines.
• Identifies and helps resolve coding or EMR workflow issues impacting coding.
• Maintains knowledge of applicable coding and reimbursement laws, regulations, and policies to ensure ethical and professional behavior.
• Performs other duties as assigned by Leadership and adheres to Trinity Health's policies and procedures.

Qualifications

Physical, Mental Requirements and Working Conditions

Hourly Pay Range : $27.96 - 41.95

Our Commitment

Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.

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