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The Outpatient Coder I 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.

An Outpatient Coder I is a coding and reimbursement expert in ICD-10-CM diagnosis coding with a focus on outpatient encounters for endoscopy lab, interventional radiology, heart catheterization lab, and outpatient clinic types.

Responsibilities:

• 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. Coding diagnosis from valid paper/electronic orders and provider reports.
• Should have expertise with HCPC Level I, II, CPT codes and national standard modifiers.
• Utilizes technical coding expertise to assign appropriate ICD-10-CM and/or CPT-4 codes to outpatient visit types when patient is seen by a provider.
• Reviews the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures
• Critical thinking demonstrated by correctly identifying issues and following processes when unable to complete coding on an account. (ADT edits, physician query for clarification of documentation, and missing documentation)
• Interprets health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
• 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
• Focus of anatomy on GI, cardiac catheterization lab, interventional radiology, outpatient diagnostics and procedures, physician order/requisition documentation
• Resolves specific Chargemaster NCCI or other outpatient edit claim failures as assigned
• Utilizes 3M Encoder resources to ensure optimal coding accuracy
• Articulates rationale for coding selections when necessary, i.e. prompted by results of data quality audit
• Meets established minimum coding productivity (90%) and quality standards (95%) for each outpatient encounter type

Required:

• Credentialed by the AHIMA (American Health Information Management Association) or AAPC (American Academy of Professional Coders)
• CE requirement to remain credentialed is 20-30 CE's every two years
• RHIT, RHIA, CCS or COC credentialed
• 2 years of related work experience in an Acute care setting

Preferred:

• 3 years of undergraduate education or equivalent

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.