Job Description

Must reside in IL, IN, IA, or WI.

The Outpatient Coder II reflects the mission, vision, and values of NM, adheres to the organization’s Code of Ethics and Corporate Compliance Program, and complies with all relevant policies, procedures, guidelines and all other regulatory and accreditation standards. Follows ICD-10-CM Official Guidelines for Coding and Reporting, Coding Clinics, interprets ICD-10-CM coding conventions and instructional notes to select appropriate diagnoses with a minimum of 95% accuracy. **** Meets established minimum coding productivity per departmental protocol and guidelines.

The Outpatient Coder II **** is the coding and reimbursement expert with ICD-10-CM diagnosis coding, HCPCS and CPT codes and modifiers. The focus is on complex outpatient encounters that include Observation stays, Same Day Surgery, Surgery Center, and Outpatient in a bed. Should have more in-depth knowledge of disease process, A&P and pharmacology as it relates to the entire body system for accurate coding and reimbursement. Expanded knowledge with HCPCS, Level I, II Chargemaster and CPT soft codes with approved facility modifiers to resolve NCCI Edits. Coder II should also have the knowledge and expertise of Coder Associate and Coder I.

_ Responsibilities:_

• Utilizes technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types. Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
• Sends appropriate physician queries when required for documentation clarification. Follows Coding Clinic for HCPCs, CPT Assistant, and interprets coding conventions and instructional notes to select appropriate diagnoses and procedures with a minimum of 95% accuracy
• Broad focus of anatomy on entire body system
• Provides technical expertise to analyze system related changes and participates in testing of software modifications. Identifies opportunities to enhance CAC (computer assisted coding), i.e. notifying IT liaison of documents filing to Default folder, incorrect system assigned codes, etc.
• Resolves NCCI Edits with approved hospital modifiers
• Utilizes 3M Encoder resources to ensure optimal coding accuracy
• Articulates rationale for coding selections, when necessary, ie. Prompted by results of data quality audit
• Meets established minimum coding productivity (90%) and quality standards (95%) for each outpatient encounter type

Qualifications

_ Required:_

• Credentialed by the AHIMA (American Health Information Management Association). CE requirement to remain credentialed is 20-30 CE's every two years
• 3-4 years of coding experience in an acute healthcare setting
• RHIT, RHIA or CCS credentialed
• Ability to work with minimal supervision

_ Preferred:_

• Bachelor’s degree in related field
• 4 years of coding experience in an acute healthcare setting

Additional Information

Northwestern Medicine is an affirmative action/equal opportunity employer and does not discriminate in hiring or employment on the basis of age, sex, race, color, religion, national origin, gender identity, veteran status, disability, sexual orientation or any other protected status.

If we offer you a job, we will perform a background check that includes a review of any criminal convictions. A conviction does not disqualify you from employment at Northwestern Medicine. We consider this on a case-by-case basis and follow all state and federal guidelines.