University of Utah Job Description
Job Summary
Outpatient/Provider Coder Level 3 responsibilities include, but are not limited to abstracting, coding, and interpreting of outpatient clinic and provider services for professional and/or facility billing. This position uses coding knowledge to abstract and record data from medical records and provides support to areas related to documentation and coding. This position codes and/or charges complex or specialty services and may serve as a resource for other coders.
Qualifications
American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) recognized certification such as: Certified Professional Coder (CPC), Certified Professional Coder-Hospital (CPC-H), Certified Professional Coder-Payer (CPC-P), Certified Coding Specialist (CCS), Certified Coding Specialist – Physician Based (CCS- P), Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), or other specialty certification indicated by the department, AND 3 years coding, clinical, or billing experience or equivalency (one year of education can be substituted for two years of related work experience). Departments may prefer specific certifications over others.
Demonstrated knowledge of clinical documentation requirements related to regulatory and reimbursement rules and regulations, reimbursement systems (federal, state and payer specific), and health insurance processing is required. Proficiency with computer software such as Microsoft Word and Excel, and effective human relations and communication skills are also required. Some areas may require knowledge of CMS, AMA, and AHA coding and billing guidelines.
This position is patient-sensitive and must fulfill all associated vaccination requirements, or be approved for an exemption, prior to the first day of work. We protect our patients, coworkers and community by requiring all patient-sensitive employees to be immunized according to CDC standards and hospital policy. Limited exemptions may be made for documented medical contraindications or religious beliefs that object to vaccinations.
Applicants must demonstrate the potential ability to perform the essential functions of the job as outlined in the position description.
Disclaimer
This job description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties, responsibilities and qualifications required of employees assigned to the job.
Essential Functions
1. Performs the final reconciliation on clinic or provider visits and resolves missing, incomplete, or inconsistent documentation by contacting appropriate personnel
2. Reviews, abstracts, and codes multiple/sub specialty services and complex or unusual cases, and assigns appropriate coding classifications
3. Interacts with and serves as a resource to coding staff, business office, providers, hospital staff, clinic managers, and other clinical personnel on billing related issues
4. Researches and resolves high volume accounts, complex or escalated suspended claims, and compliance issues using appropriate databases and shares this information with other coding staff
5. Researches, interprets, and applies regulatory guidelines to coding and reimbursement decisions and educates staff on associated guidelines and resolutions
6. Assists in the auditing process
7. Trains Level 1 & 2 Coders and may serve as project lead
8. Assists with backlog to maintain department quality and productivity standards
9. Assists with other department coding needs as requested
10. May participate on committees and/or workgroups
11. May formally present information to providers and assist in training efforts regarding coding/billing
Problem Solving
Incumbents in this position frequently use independent judgment, analysis, and logic to initiate, adapt, and formulate solutions to problems. Incumbents are expected to be able to identify and evaluate sources of information for accuracy, relevance, and credibility. Incumbents should also be able to assess personal learning and recognize gaps in knowledge, both in their personal performance and in training others. The ability to adapt and apply information to a variety of situations is important.
Comments
Incumbents in this position must maintain their Continuing Education Credits (CEUs) as required by the issuing coding organization.
Work Environment and Level of Frequency typically required
Nearly Continuously: Office environment.
Physical Requirements and Level of Frequency that may be required
Nearly Continuously: Sitting, hearing, listening, talking.
Often: Repetitive hand motion (such as typing), walking.
Seldom: Bending, reaching overhead.
The staff member must be able to demonstrate the knowledge and skills necessary to provide care appropriate to the age of the patients served on his or her assigned unit. The individual must demonstrate knowledge of the principles of life span growth and development and the ability to assess data regarding the patient's status and provide care as described in the department's policies and procedures manual.
