Lead Certified Coder, Outpatient SDS-OBSV (Remote)

Education and Work Experience:

• High School Education/GED or equivalent: Required
• Working knowledge of hospital Cerner EMR (electronic medical record): Required
• Five years' SDS/OBV coding and health care experience: Required

Licenses/Certifications:

• AHIMA Certified Coding Specialist (CCS): Required

Essential Functions:

• Reviews APC and payor denials and provides feedback to leadership and other departments. Performs outpatient audits including payor audits and overall coding accuracy audits. Maintains denial and other spreadsheets for assigned denial and audit duties. Attends various meetings and provides coding feedback. Researches and provides feedback and direction to outpatient coding associates. Ensures coding corrections and edits are updated. Keeps abreast of regulatory changes related to coding and documentation and communicates these updates and changes to coding and leadership. Provides edicational sessions and training resources to coding associates. Understands and assists leadership and coding with reaching departmental metric goals. Abstracts and assigns ICD-10-CM diagnosis codes and CPT procedure codes from the SDS and OBV patient record to ensure accurate APC assignment and to provide information required for reimbursement and statistical data submissions.
• Validates appropriate dates of service against documentation in the EMR for SDS/OBV encounters. Completes required abstract fields in registration conversation on SDS/OBV encounter for OSHPD and other data submissions. Uses knowledge of modifier use to ensure accurate application on various payor types. Communicates with appropriate departments related to charge corrections/modifications. Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory agencies. Follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. Reviews, understands and applies quarterly coding clinics, coding guidelines and coding conventions of ICD-10-CM references. Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accurateness of documentation and physician coding practices. Analyzes content of reports and software edits to facilitate revisions with appropriate departments - NCCI edits.
• Follows up coding holds, revenue cycle department holds including related and all other email communication.
• Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accuracy of documentation and physician coding practices. Maintains required online Healthstream education courses.
• Attends meetings and training pertaining to coder education, audit reviews, staff meetings, outpatient coder roundtable meetings, and SDC to OBV charges.
• Performs other job-related duties as assigned.

Organizational Requirements:

Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
Adventist Health participates in E-Verify. Visit https://adventisthealth.org/careers/everify/ for more information about E-Verify. By choosing to apply, you acknowledge that you have accessed and read the E-Verify Participation and Right to Work notices and understand the contents therein.