Use and maintain electronic applications and work processes to support clinical classification and coding (for example, encoding and grouping software)
Demonstrates understanding in use and application of encoder and grouper software
Apply outpatient diagnosis and procedure codes according to current nomenclature and demonstrate adherence to current regulations and established guidelines in code assignment (focus on assignment of first listed diagnosis, and sequencing as well as other clinical coding guidelines)
Audits indicate appropriate code and sequencing use following regulations and guidelines
Ensure accuracy of diagnostic/procedural APC (Ambulatory Payment Classification) system
Audits indicate accuracy of APC assignment
Validate outpatient coding accuracy using clinical information found in the health record
Audits indicate accuracy of diagnostic and procedural coding
Use and maintain applications and processes to support other clinical classification and nomenclature as appropriate to the work setting (e.g., DSM V (Diagnostic and Statistical Manual of Mental Disorders), SNOMED-CT (Systematized Nomenclature of Medicine - Clinical Terms)
Identifies correct coding nomenclature for patient type and location
Resolve discrepancies between coded data and supporting documentation. Communicates with providers to ensure appropriate documentation.
Creates compliant physician queries
Apply policies and procedures for the use of clinical data required in reimbursement and outpatient prospective payment systems (OPPS) in healthcare delivery as well as changing regulations among various payment systems for healthcare services such as Medicare, Medicaid, managed care, etc.
Adheres to national, regional and facility-specific requirements for accurate reimbursement by payer type
Support accurate billing through coding, chargemaster, claims management, and bill reconciliation processes
Reviews codes identified manually and by the chargemaster to ensure compliant billing
Use established guidelines to comply with reimbursement and outpatient reporting requirements such as the National Correct Coding Initiative and others
Follows coding edits for compliance with NCCI
Compile patient data and perform data quality reviews to validate code assignment and compliance with reporting requirements such as outpatient prospective payment systems
Participates in coding audits
Participate in compliance (fraud and abuse), HIPAA (Health Insurance Portability and Accountability Act of 1996), and other organization specific training.
Attends required compliance training