SUMMARY:

Reports to the Coding Manager. Reviews the outpatient clinical documentation of extract data and assign appropriate ICD-10-CM and CPT codes in accordance with the outpatient

ICD-10-CM

Official Guidelines for Coding and Reporting and the

AHA HCPCS

Coding Clinics. Reviews the medical records to ensure the documentation supports the code assignment. Utilizes 3M 360 Finder for code assignment and appropriate resolutions of claim edits (CCI, NCD, OCE, etc.) Confer with physician for clarification as needed. Monitors outpatient uncoded report to ensure timely coding and billing process. Maintains and meets HIS quality and productivity standards. Brown University Health employees are expected to successfully role model the organization's values of Compassion, Accountability, Respect, and Excellence as these values guide our everyday actions with patients, customers and one another. In addition to our values, all employees are expected to demonstrate the core Success Factors which tell us how we work together and how we get things done.

The core Success Factors include:

Instill Trust and Value Differences Patient and Community Focus and Collaborate

RESPONSIBILITIES

Enters codedbstracted information into 3M 360 Finder assigning accurate APC and reviewing all coding edits appearing in 3M. Understands and follows all National Correct Code Initiative Edits (NCCI) and follows pertinent medical necessity requirements. Resolves accounts on the claims edit database. Assigns injections and infusion codes for observation patients. Meets the minimum productivity standard mintaining an average accuracy rating of 95%.Assigns E/M, ICD-10-CM, CPT or chargemaster codes to clinic visits ensuring medical record documentation supports the code. Should physicians have entered in diagnosis, ICD or CPT codes, ensures they are accurate and supported by documentation in the medical record. Utilizes 3M to identify and resolve NCCI edits before final billing. Reports documentation insufficiencies to the responsible physician. Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and 1995 Evaluation and Management Guidelines for patients less than 18 years of age.

Monitors and resolves rejected accounts on the Claims Edit Report and e Clinical Works error reports by established timeframe researching coding conflicts including chargemaster, medical necessity and various other coding and billing issues. Refers complex coding issues to the coding validator or supervisor.

Reviews pertinent outpatient uncoded reports researching and resolving old uncoded accounts and any accounts posted on report for which the charges are inappropriate. Updates patient financial accounts in the Patient Management and Patient Accounting billing system as required. Follows established procedures for rebilling accounts.

Performs related clerical duties as required.pMaintains level of knowledge and expertise pertinent to the position.

MINIMUM QUALIFICATIONS

BASIC

KNOWLEDGE

High school diploma or equivalent. Successful completion of formal coding educational program. Ability to read and understand outpatient clinic medical record documentation for reporting of outpatient clinic, ancillary and endoscopies. Coding certification required from the American Health Information Management Association (AHIMA) or the American Academy of Professional Coders (AAPC).

EXPERIENCE

One to two years experience in outpatient coding or billing. Ability to meet and maintain established quality and productivity standards.

WORKING CONDITIONS

Requires long periods of sitting to review medical records. Ability to lift a minimum of 25 pounds, bend, stoop, stretch, use step-stools to file records. Ability to work under stressful conditions to maintain accounts receivable days achieving productivity and accuracy.

INDEPENDENT ACTION

Performs independently within the department's policies and practices. Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

SUPERVISORY RESPONSIBILITY

None Pay Range:

$24.29-$40.07

EEO Statement:

Brown University Health is committed to providing equal employment opportunities and maintaining a work environment free from all forms of unlawful discrimination and harassment.

Location:

Corporate Headquarters - 15 LaSalle Square Providence, Rhode Island 02903

Work Type:

8:00am-4:30pm

Work Shift:

Day Daily Hours:

8 hours

Driving Required:

No As Rhode Island's largest health system and private employer, Brown University Health is the state's premier provider of health services and includes the only Level I Trauma Center for southeastern New England. Today, more than 20,000 people work at Brown University Health and bring their unique skills, experiences, and compassion to their jobs every day. Formed in 1994, Brown University Health is a not-for-profit health system based in Providence, RI comprising three teaching hospitals of

The Warren Alpert Medical School of Brown University:

Rhode Island Hospital and its Hasbro Children's; The Miriam Hospital; and Bradley Hospital, the nation's first psychiatric hospital for children; Newport Hospital, Saint Anne's Hospital and Morton Hospital, community hospitals offering a broad range of health services; Gateway Healthcare, the state's largest provider of community behavioral health care; and Brown Health Medical Group, the largest multi-specialty practice in Rhode Island. Brown University Health is an equal opportunity employer that values diversity of cultural background, race, gender, age, religion, identity, ability, and perspectives - we are actively committed to a diverse workforce that represents the patients and community that we serve. We are invested in creating a respectful, inclusive, and equitable environment that supports the holistic well-being of our employees and their families. Join us and help build a healthier future for our patients - and for yourself. 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