Remote Coding Specialist - Ancillary & Claim Edits
Saint Joseph Mercy Health SystemFull time Full day
The Remote Coding Specialist I - Ancillary Coding & Claim Edits is responsible for coding outpatient diagnostic healthcare records (lab, radiology, cardiology etc.), series and facility clinic by assigning the appropriate ICD-10-CM classification for valid diagnoses and validating CPT codes for procedures. This position also is responsible for Claim Edits and will review and respond to NCCI, OCE, LCD & NCD edits
The Remote Coding Specialist I - Ancillary Coding & Claim Edits is responsible for coding outpatient diagnostic (lab, radiology, cardiology etc.), series and facility clinic healthcare records by assigning the appropriate ICD-10-CM classification for valid diagnoses and validating CPT codes for procedures. This position also is responsible for Claim Edits and will review and respond to NCCI, OCE, LCD & NCD edits. The coding information is used to determine APC’s (Ambulatory Payment Classification) for data quantitative analysis, quality research and claim submission.The Ancillary Remote Coding Specialist will use the EPIC and 3M software to identify appropriate codes and ensure the completeness of the coding record, investigate and track unbilled accounts, and work with appropriate resources to ensure timely filing/billing.Outpatient Surgery coding experience is helpful, but not required, as training can be provided based on experience. Infusion and Wound Care coding experience is preferred. 2 years coding experience preferred.
Essential Functions and Responsibilities
- Reviews the Electronic Health Record to determine Principal diagnoses, Secondary diagnoses and significant procedures to assign appropriate ICD & CPT codes for data retrieval, research and reimbursement purposes.
- Uses 3M electronic encoder and electronic code book to determine appropriate coding guidelines.
- Abstract outpatient data into EPIC abstract for research projects, quality improvement studies, and statistical reporting.
- Utilizes 3M Audit Expert, NCCI & OCE edits, LCD’s & NCD’s to determine appropriateness and completeness of coding and health record documentation.
- Codes accounts on a timely basis by payor’s cut-off dates under the “Just-in-Time” philosophy.
- Investigates and tracks unbilled accounts in EPIC to determine reason for incomplete status and works with appropriate resources for completion.
- Collaborates with Medical Staff and Clinical Documentation Specialists to ensure that documentation in health record supports services provided-to accurately and compliantly assign codes.
- Collaborates with members of various ancillary departments to complete special projects, also may serve on both intradepartmental and interdepartmental committees and task forces.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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