Quorum Health

Medical Billing and Coding

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance.
• Will match outpatient coding area to experience (i.e. Same Day Surgery, Routine Outpatient, Physician, Recurring, Observation, etc.).
• Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using 3M encoder, reviews Ambulatory Payment Classifications (APC) and coding edits.
• Reviews Local/National Coverage Determination (LCD/NCD) edits and guidance for codes meeting medical necessity.
• Research electronic medical record for any additional diagnoses documented to meet medical necessity.
• Ability to assign Physician E/M levels and charges for all relevant procedures performed in various settings, if applicable.
• Ability to assign injections and infusions, if applicable.

Outpatient Acute Care Coder

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• Reviews medical records for the determination of accurate assignment of all documented diagnoses and procedures.
• Adheres to Standards of Ethical Coding (AHIMA).
• Reviews medical records to determine accurate required abstracting elements including appropriate discharge disposition.
• Knowledge of MS-DRG and APR DRG classifications and reimbursement structures.
• Stays current with AHA Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and ICD-10-PCS coding.
• Comprehensive understanding of CCs/MCCs, impact on quality reporting, UHDDS guidelines, HACs and PSIs.
• The Inpatient Coder shall review hospital medical documentation to assign and sequence the appropriate principal diagnosis, secondary diagnoses and procedures utilizing ICD-10-CM, ICD-10-PCS codes with inpatient encounters to ensure proper coding, billing and compliance.
• Experience with compliant physician query writing.

Outpatient Acute Care Coder

Coder – Day Surgery