Ambulatory Coder -Outpatient Professional Billing Coding

The Ambulatory Coding and Reimbursement Specialist is responsible for reviewing, analyzing, and coding ambulatory and/or hospital encounters, diagnostic and procedural information used in the billing of charges for physician’s services. Ensures compliance with established coding procedures, regulatory guidelines and reimbursement policies. Reviews medical record documentation for E/M encounters from multiple specialty departments for proper assignment of ICD-10, CPT, HCPCS and modifiers.  Performs initial charge review to determine appropriate CPT and ICD-10 codes to be used in reporting physician services to third party payers.

Essential Duties and Responsibilities:

• Analyzes provider documentation to assure the appropriate Evaluation & Management levels are assigned using the correct CPT and current Evaluation and Management Guidelines
• Interprets outpatient office visit notes and charge documents to determine services provided and accurately assign CPT , Modifiers, and ICD-10 coding to these services.
• Performs a comprehensive review of the record to assure all vital information such as patient identification, signatures, and dates are present in the record.
• Evaluates the records for documentation consistency and adequacy. Ensured that he inlay diagnosis accurately reflects the care and treatment rendered.
• Monitors and follows up to ensure all services billed are captured and coded.
• Follows and adheres to all WWT policies such as Coding Audit Policy and Physician Coding Query In-Basket Policy
• Provide real time feedback to providers on all coding changes and trends via EPIC in basket message
• Actively participates and engages coding team meetings regularly and if needed
• Reviews all physician documentation to ensure compliance with third party and regulatory guidelines. 
• Works in coordination with other members of the physician’s office/departments as necessary.
• Collaborates with Coding Management for special coding and billing projects if assigned.
• Apply coding knowledge and skills to resolve coding denials from payers and works with management and various departments.
• Resolving coding denials assigned by applying coding knowledge and skills.
• Maintains active coding credentials and CEU’s required for coding roles.
• Performs other related duties as required and assigned.

Knowledge, Skills & Abilities

• Knowledge and understanding of medical coding and billing systems and regulatory requirements
• Communication - communicates clearly and concisely, verbally and in writing.
• Persistence – comfortable pursuing, rebutting and escalating issues as appropriate.
• Goal-oriented – holds him/herself accountable to achieving shared professional and personal goals.
• Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Interpersonal skills – establishing and maintaining effective working relationships with employees, and external parties.
• PC skills - demonstrates high proficiency in Microsoft Office applications, especially Microsoft Excel, and others as required.
• Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.

Education/Experience:

• Certified professional coder CCS-P, CPC, RHIT or RHIA through AAPC or AHIMA with a minimum of two years’ experience with CPT/ICD-10 coding of multispecialty services preferred. Responsible for maintaining continuing education per certification requirements.
• Clear understanding of protocols and procedures in a medical office including health information management, confidentiality, and safety.
• Organize and prioritize responsibilities while remaining flexible to changing demands.
• Excellent written and oral communication skills, with the ability to interact with patients, families, staff and others.
• Strong analytical skills and attention to detail
• Ability to establish priorities and work independently
• Must have high level of discretion and judgment.