What are the responsibilities and job description for the Outpatient Coding Specialist I position at Alaska Native Tribal Health Consortium (ANTHC)?
The Alaska Native Tribal Health Consortium is a non-profit Tribal health organization designed to meet the unique health needs of Alaska Native and American Indian people living in Alaska. In partnership with the more than 171,000 Alaska Native and American Indian people that we serve and the Tribal health organizations of the Alaska Tribal Health System, ANTHC provides world-class health services, which include comprehensive medical services at the Alaska Native Medical Center, wellness programs, disease research and prevention, rural provider training and rural water and sanitation systems construction.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary
Under direct supervision, performs coding on all diagnoses, procedures, professional services, and supplies.
Responsibilities
All
R esponsible for abstracting, coding, and sequencing the classification of medical and surgical procedures, professional services, diagnosis, supplies and treatment modalities into software programs.
S elects the most accurate and descriptive codes from the listings of American Medical Association Current Procedural Terminology (CPT-4) Coding system, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); and Healthcare Common Procedure Coding System (HCPCS).
C odes facility and professional components of outpatient clinic, radiology accounts, laboratory services, and ED charge capture .
U ses the most accurate codes to capture highest level of specificity for social determinants of health, reimbursement purposes, research, statistical analysis, quality of care, and communication to support the patient’s treatment.
M aintains the confidentiality of patient records and procedures. Follows official coding guidelines to extracts pertinent data from the patient’s health record, and determines appropriate coding using the official coding guidelines.
P rovides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Sends coding queries to providers to request missing information.
M aintains electronic filing systems. Retrieves, reviews, and compiles data for reports as directed.
R eviews and analyzes medical records to assure the record is complete and accurate, includes signatures and supporting documentation, and meets the requirements for accrediting agencies and reimbursement agencies.
R eviews and resolves system edits, MUE’s, NCCI edits, status indicators, modifiers.
W orks under direct supervision of the coding manager.
P erforms other duties as assigned.
O utpatient Coding Specialist II
M aster all Outpatient Coding Specialist I duties. In addition, provides training and mentoring to new employees as needed. Performs routine audits independently and participates in performance improvement activities.
P rovide reports of findings and feedback to parties involved. Provides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Codes the facility and professional components of outpatient specialty, ED, and advanced radiology encounters.
O utpatient Coding Specialist III
M aster all Outpatient Coding Specialist I & II duties.
P erforms other duties as assigned. Codes the most complex outpatient accounts, including facility and professional components of surgical and observation accounts.
Other Information
KNOWLEDGE and SKILLS
A ll
Knowledge of medical terminology and abbreviations; anatomy and physiology; major disease processes and pharmacology.
Knowledge of classification systems, including CPT-4, E&M, ICD-9-CM, and HCPCS nomenclature, coding rules and guidelines.
Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), AHIMA, and AAPC for assignment of diagnostic and procedural codes.
Knowledge of Health Information Management theory, principles, practices, techniques, concepts and policies.
Knowledge of the Privacy Act of 1974, The Joint Commission and HIPAA Privacy Rule Act of 1966.
Skill in understanding medical billing procedures and protocols.
Skill in linking diagnosis to services and applying appropriate codes to diagnosis, procedures, evaluation and management, and supplies.
Skill in operating a personal computer utilizing a variety of software applications.
Skill in operating computerized medical data entry and information processing systems.
Skill in oral communication and presenting information to providers.
Skill in writing reports and other materials.
O utpatient Coding Specialist II
M oderate skill in training and educating Level I coders.
A bility to review accounts and provide feedback by explaining and instructing effectively.
O utpatient Coding Specialist III
A dvanced Skill in training and educating Level I & II coders.
A bility to review accounts and provide feedback by explaining and instructing effectively.
A bility to work independently.
MINIMUM EDUCATION QUALIFICATION
A ll
A high school diploma or GED equivalent. Completion of a certificate program in coding through the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
mInimum Experience Qualification
O utpatient Coding Specialist I
S ix (6) months of practicum experience in any of the following coding classification systems: ICD-10-CM or CPT.
O Utpatient Coding Specialist II
T wo years of relevant coding experience.
O Utpatient Coding Specialist III
T hree years of relevant coding experience.
MINIMUM CERTIFICATION QUALIFICATION
A ll – a minimum of one of the below certifications is required:
C ertified Professional Coder Associate (CPC-A)
C ertified Coding Associate (CCA)
O utpatient Coding Specialist II & III – a minimum of one of the below certifications is required:
C ertified Professional Coder Associate (CPC-S)
C ertified Professional Coder (CPC)
C ertified Coding Specialist (CCS)
C ertified Coding Specialist – Physician (CCS-P)
C ertified Coding Specialist – Hospital (CCS-H)
R egistered Health Information Technician (RHIT)
R egistered Health Information Administrator (RHIA)
PREFERRED EDUCATION QUALIFICATION
N /A
Preferred Experience Qualification
N /A
PREFERRED CERTIFICATION QUALIFICATION
N /A
a Dditional Requirements
A ll
M ay be required to work outside the traditional work schedule.
ANTHC is the largest, most comprehensive Tribal health organization in the United States, and Alaska’s second-largest health employer with more than 3,100 employees offering an array of health services to people around the nation’s largest state.
Our vision: Alaska Native people are the healthiest people in the world.
ANTHC offers a competitive and comprehensive Benefits Package for all Benefit Eligible Employees, which includes:
- Medical Insurance provided through the Federal Employee Health Benefits Program as a Tribal Employee, with over 20 plans and tiers.
- Cost-Share Dental and Vision Insurances
- Discounted Pet Insurance
- Retirement Contributions with Pre-Tax or Roth options into a 403(b).
- Retirement Match and Discretionary. ANTHC matches up to 5%, with a 3% discretionary contribution after one year of employment into a 401(a).
- Paid Time Off starts immediately, earning up to 6 hours per pay period, with paid time off accruals increasing based on years of service.
- Twelve Paid Holidays
- Paid Parental Leave or miscarriage/stillbirth eligibility after six months of employment
- Basic Short/Long Term Disability premiums, Accidental Death and Dismemberment (AD&D) Insurance, and Basic Life Insurance are covered 100% by ANTHC, with additional options for Short-Term Disability Buy-Up Coverage and Voluntary Life for yourself and your family members.
- Flexible Spending Accounts for Healthcare and Dependent Care.
- Ancillary Cash Benefits for accident, hospital indemnity, and critical illness.
- On-Site Child Care Facility with expert-designed classrooms for early child development and preschool.
- Employee Assistance Program with support for grief, financial counseling, mental/emotional health, and discounted legal advice.
- Tuition Discounts for you and your eligible dependents at Alaska Pacific University.
- On-Site Training Courses and Professional Development Opportunities.
- License and certification reimbursements and occupational insurance for medical staff.
- Gym Access to Alaska Pacific University includes a salt water pool, rock climbing, workout gym, and steep discounts for outdoor equipment rentals.
- Emergency Travel Assistance
- Education Assistance or Education leave eligibility
- Discount program for travel, gym memberships, amusement parks, and more.
Alaska Native Tribal Health Consortium has a hiring preference for qualified Alaska Native and American Indian applicants pursuant to P.L. 93-638 Indian Self Determination Act.
Summary
Under direct supervision, performs coding on all diagnoses, procedures, professional services, and supplies.
Responsibilities
All
R esponsible for abstracting, coding, and sequencing the classification of medical and surgical procedures, professional services, diagnosis, supplies and treatment modalities into software programs.
S elects the most accurate and descriptive codes from the listings of American Medical Association Current Procedural Terminology (CPT-4) Coding system, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM); and Healthcare Common Procedure Coding System (HCPCS).
C odes facility and professional components of outpatient clinic, radiology accounts, laboratory services, and ED charge capture .
U ses the most accurate codes to capture highest level of specificity for social determinants of health, reimbursement purposes, research, statistical analysis, quality of care, and communication to support the patient’s treatment.
M aintains the confidentiality of patient records and procedures. Follows official coding guidelines to extracts pertinent data from the patient’s health record, and determines appropriate coding using the official coding guidelines.
P rovides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Sends coding queries to providers to request missing information.
M aintains electronic filing systems. Retrieves, reviews, and compiles data for reports as directed.
R eviews and analyzes medical records to assure the record is complete and accurate, includes signatures and supporting documentation, and meets the requirements for accrediting agencies and reimbursement agencies.
R eviews and resolves system edits, MUE’s, NCCI edits, status indicators, modifiers.
W orks under direct supervision of the coding manager.
P erforms other duties as assigned.
O utpatient Coding Specialist II
M aster all Outpatient Coding Specialist I duties. In addition, provides training and mentoring to new employees as needed. Performs routine audits independently and participates in performance improvement activities.
P rovide reports of findings and feedback to parties involved. Provides feedback and education to physician and professional staff regarding changes in coding methodology and enhanced documentation procedures for optimizing reimbursement. Codes the facility and professional components of outpatient specialty, ED, and advanced radiology encounters.
O utpatient Coding Specialist III
M aster all Outpatient Coding Specialist I & II duties.
P erforms other duties as assigned. Codes the most complex outpatient accounts, including facility and professional components of surgical and observation accounts.
Other Information
KNOWLEDGE and SKILLS
A ll
Knowledge of medical terminology and abbreviations; anatomy and physiology; major disease processes and pharmacology.
Knowledge of classification systems, including CPT-4, E&M, ICD-9-CM, and HCPCS nomenclature, coding rules and guidelines.
Knowledge of coding conventions and rules established by the American Medical Association (AMA), the Center for Medicare and Medicaid (CMS), AHIMA, and AAPC for assignment of diagnostic and procedural codes.
Knowledge of Health Information Management theory, principles, practices, techniques, concepts and policies.
Knowledge of the Privacy Act of 1974, The Joint Commission and HIPAA Privacy Rule Act of 1966.
Skill in understanding medical billing procedures and protocols.
Skill in linking diagnosis to services and applying appropriate codes to diagnosis, procedures, evaluation and management, and supplies.
Skill in operating a personal computer utilizing a variety of software applications.
Skill in operating computerized medical data entry and information processing systems.
Skill in oral communication and presenting information to providers.
Skill in writing reports and other materials.
O utpatient Coding Specialist II
M oderate skill in training and educating Level I coders.
A bility to review accounts and provide feedback by explaining and instructing effectively.
O utpatient Coding Specialist III
A dvanced Skill in training and educating Level I & II coders.
A bility to review accounts and provide feedback by explaining and instructing effectively.
A bility to work independently.
MINIMUM EDUCATION QUALIFICATION
A ll
A high school diploma or GED equivalent. Completion of a certificate program in coding through the American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC).
mInimum Experience Qualification
O utpatient Coding Specialist I
S ix (6) months of practicum experience in any of the following coding classification systems: ICD-10-CM or CPT.
O Utpatient Coding Specialist II
T wo years of relevant coding experience.
O Utpatient Coding Specialist III
T hree years of relevant coding experience.
MINIMUM CERTIFICATION QUALIFICATION
A ll – a minimum of one of the below certifications is required:
C ertified Professional Coder Associate (CPC-A)
C ertified Coding Associate (CCA)
O utpatient Coding Specialist II & III – a minimum of one of the below certifications is required:
C ertified Professional Coder Associate (CPC-S)
C ertified Professional Coder (CPC)
C ertified Coding Specialist (CCS)
C ertified Coding Specialist – Physician (CCS-P)
C ertified Coding Specialist – Hospital (CCS-H)
R egistered Health Information Technician (RHIT)
R egistered Health Information Administrator (RHIA)
PREFERRED EDUCATION QUALIFICATION
N /A
Preferred Experience Qualification
N /A
PREFERRED CERTIFICATION QUALIFICATION
N /A
a Dditional Requirements
A ll
M ay be required to work outside the traditional work schedule.
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