Hospital Outpatient Coding Reimbursement Specialist

Work From Home

Work From Home Work From Home, Indiana 46544

The Hospital Outpatient Reimbursement Specialist reviews electronic medical record documentation, and applies ICD and CPT codes, per Official Coding Guidelines. With additional knowledge of alternate payment methodologies, such as enhanced ambulatory payment groups (EAPG), codes are assigned and sequenced to ensure optimum severity of illness and risk of mortality, and grouping. This position also abstracts key data elements necessary for billing and data analysis.

WHO WE ARE

With 12 ministries and access points across Indiana and Illinois, Franciscan Health is one of the largest Catholic health care systems in the Midwest. Franciscan Health takes pride in hiring coworkers that provide compassionate, comprehensive care for our patients and the communities we serve.

WHAT YOU CAN EXPECT

Serves as coding subject matter expert for one of the following reimbursement methodologies Illinois Outpatient Medicaid (knowledge and understanding of EAPGs reimbursement methodologies and edits); Indiana Outpatient Medicaid (knowledge and understanding of EAPGs reimbursement methodologies and edits) with experience in Hospital OP Surgical Coding for Same Day Surgery, Observation and Emergency Room procedural coding.

Demonstrates a expert knowledge of coding guidelines, medical terminology, anatomy / physiology, reimbursement schemes, and payer specific guidelines. Understands how ICD codes, EAPGs and SOI / ROM scores are used for reimbursement, public reporting of outcomes, reviewing quality of patient care, financial modeling, strategic planning and marketing.

Applies broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability.

Remains current with coding and industry changes through participation in educational opportunities to maintain coding credentials.

Reviews and analyzes the content of the medical record to determine when documentation should be utilized for appropriate assignment of ICD diagnosis codes, CPT surgical procedures, modifiers, hierarchical condition categories, complications, and comorbidities to meet coding guidelines.

Identify cases that may require provider documentation clarification regarding documentation inconsistencies or lack of specificity to accurately assign codes. Collaborates with clinical departments and physicians on documentation improvement.

QUALIFICATIONS

High School Diploma / GED - Required

Associates or Bachelors Degree - Preferred

3 years Coding - Required

Certified Coding Specialist (CCS) - Required

Registered Health Information Technician (RHIT) - Preferred

Registered Health Information Administrator (RHIA) - Preferred

TRAVEL IS REQUIRED : Never or Rarely

JOB RANGE :

Hospital Outpatient Coding Reimbursement Spcl $22.70-$33.77

INCENTIVE : Not Applicable

EQUAL OPPORTUNITY EMPLOYER

It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law.

Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights.

Franciscan Alliance is committed to equal employment opportunity.

Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org .