编码专员 - 门诊远程办公
Coding Specialist - Outpatient Telecommute
SUMMARY:
向专业编码经理汇报，专业编码专员负责对医生及其他合格医疗保健提供者的服务进行ICD-10-CM、CPT和HCPCS第II级代码的准确审查、解释和分配。该职位确保编码准确性并符合联邦法规、付款方指南和组织政策，以支持适当的报销并降低审计风险。
编码专员与提供者、收入周期团队和临床团队合作，确保完整的、准确的和合规的文档和编码实践。
向专业编码经理汇报，专业编码专员负责对医生及其他合格医疗保健提供者的服务进行ICD-10-CM、CPT和HCPCS第II级代码的准确审查、解释和分配。该职位确保编码准确性并符合联邦法规、付款方指南和组织政策，以支持适当的报销并降低审计风险。
编码专员与提供者、收入周期团队和临床团队合作，确保完整的、准确的和合规的文档和编码实践。
布朗大学健康员工需要成功地树立组织价值观：同理心、责任感、尊重和卓越，这些价值观指导我们日常与患者、客户及彼此的行动。
除了我们的价值观，所有员工都需要展示核心成功因素，这些因素告诉我们如何协作以及如何完成工作。核心成功因素包括：
建立信任并重视差异
以患者和社区为中心并进行协作
职责：
将编码提取的信息输入3M 360 Finder，分配准确的APC并审查3M中出现的所有编码编辑。了解并遵循所有国家正确编码倡议编辑（NCCI），并遵循相关的医疗必要性要求。解决索赔编辑数据库中的账户。为观察患者分配注射和输液代码。达到最低生产率标准，保持平均准确度评级为95%。
为诊所就诊分配E/M、ICD-10-CM、CPT或收费主数据库代码，确保医疗记录文档支持该代码。如果医生已输入诊断、ICD或CPT代码，确保它们准确且有医疗记录中的文档支持。使用
查看英文原文
SUMMARY:
Reporting to the Manager of Professional Coding, the Professional Coding Specialist is responsible for the accurate review, interpretation, and assignment of ICD-10-CM, CPT, and HCPCS Level II codes for physician and other qualified healthcare provider services. This role ensures coding accuracy and compliance with federal regulations, payer guidelines, and organizational policies to support appropriate reimbursement and minimize audit risk.
The Coding Specialist collaborates with providers, revenue cycle teams, and clinical teams to ensure complete, accurate, and compliant documentation and coding practices.
Reporting to the Manager of Professional Coding, the Professional Coding Specialist is responsible for the accurate review, interpretation, and assignment of ICD-10-CM, CPT, and HCPCS Level II codes for physician and other qualified healthcare provider services. This role ensures coding accuracy and compliance with federal regulations, payer guidelines, and organizational policies to support appropriate reimbursement and minimize audit risk.
The Coding Specialist collaborates with providers, revenue cycle teams, and clinical teams to ensure complete, accurate, and compliant documentation and coding practices.
Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another.
In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done. The core Success Factors include:
Instill Trust and Value Differences
Patient and Community Focus and Collaborate
RESPONSIBILITIES:
Enters codedbstracted information into 3M 360 Finder assigning accurate APC and reviewing all coding edits appearing in 3M. Understands and follows all National Correct Code Initiative Edits (NCCI) and follows pertinent medical necessity requirements. Resolves accounts on the claims edit database. Assigns injections and infusion codes for observation patients. Meets the minimum productivity standard mintaining an average accuracy rating of 95%.
Assigns E/M, ICD-10-CM, CPT or chargemaster codes to clinic visits ensuring medical record documentation supports the code. Should physicians have entered in diagnosis, ICD or CPT codes, ensures they are accurate and supported by documentation in the medical record. Utilizes 3M to identify and resolve NCCI edits before final billing. Reports documentation insufficiencies to the responsible physician. Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients less than 18 years of age.
Monitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Refers complex coding issues to the coding validator or supervisor.
Reviews pertinent outpatient uncoded reports researching and resolving old uncoded accounts and any accounts posted on report for which the charges are inappropriate. Updates patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follows established procedures for rebilling accounts.
Performs related clerical duties as required.
Maintains level of knowledge and expertise pertinent to the position.
Compliance & Regulatory Adherence
- Maintain compliance with CMS regulations, National Correct Coding Initiative (NCCI) edits, Medicare Administrative Contractor (MAC) guidance, payerpoliciesandorganizational policies.
- Participate in compliance initiatives to reduce coding-related denials and audit findings.
- Ensurescompliance with HIPAA,organizational data privacy,and security policies.
- Query compliance and appropriatenessin accordance withACDIS/AHIMA Guidelines for Achieving a Compliant Query Practice
- Abides by the Standards ofEthical Coding as set forth by the American Health Information ManagementAssociation and the American Association of Professional Coders.
Performance Metrics
- Meets or exceeds 95%codingaccuracy rate
- Achievesproductivity benchmarks
- Demonstratesconsistent performance in accuracy, timeliness, and workload management
- Adheresto organizational coding guidelines, payer requirements, and documentation standards to support audit readiness and reimbursement integrity
- Accurately resolvescoding edits, denials, and discrepancies
MINIMUM QUALIFICATIONS:
Education
- High school diploma or equivalent required
Certifications
One or more of the following required:
- CPC (Certified Professional Coder) – AAPC
- CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA
Experience
- 1–3+ years of professional (physician-based) coding experience
- Specialty experience a plus Strong knowledge of:ICD-10-CM, CPT, and HCPCS Level II coding guidelines
- Medical terminology, anatomy, and healthcare documentation
- Ability to interpret complex medical documentation and apply coding guidelines accurately
- Strong written and verbal communication skills
- Proficiencywith electronic health records (EHR), Epic experiencepreferred
- E/M coding and/or surgical/procedural coding
Work Environment
- Fully Remote: Must maintain a secure, private workspace to protect PHI.Required to use organization-approved secure systems (VPN, multi-factor authentication).Maintains active communication via email, messaging platforms, andattendsvirtual meetings, as scheduled.
Working conditions:Requireslong periodsof computer use to review medical records. Ability to meet deadlines while achieving productivity and accuracy standards.
Independent action:Demonstratesability to work independentlywithin the department’s policies and practices.Refersspecific complex problems to the supervisor when clarification of the departmental policies and procedures arerequired.
Supervisory responsibility:None
Disclaimer
This job description is intended to describe the general nature and level of work performed. Duties and responsibilities may be adjusted based on organizational needs and regulatory requirements.
Pay Range:
$24.29-$40.07EEO Statement:
Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.
Location:
Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903Work Type:
M-F 8am-4:30pmWork Shift:
DayDaily Hours:
8 hoursDriving Required:
NoOriginally posted on Himalayas