This multifaceted role involves managing day-to-day Outpatient Coding AR activities, ensuring accuracy and timeliness through collaboration with internal and partner departments to resolve outstanding issues and streamline workflows. The Senior Coder also serves as a subject matter expert, conducts regular Quality Assurance reviews, educates staff, and performs production coding as needed to meet deadlines.
Requirements summary
Candidates must possess a Bachelor's degree (preferred) and hold a required coding credential (COC, CIC, CCS, RHIA, or RHIT), along with five or more years of progressive Outpatient Coding experience covering all service lines. Strong proficiency in ICD-10, CPT, PCS, Epic, and 3M is mandatory, alongside advanced Excel skills for tracking and reporting.
To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.
Reporting to the Supervisor of Outpatient Coding, The OP Senior Coder is a vital multifaceted role within the Outpatient Coding Department.
This position provides support to the Outpatient Coding Department as a OP coding subject matter expert, educator, QA reviewer, and also focuses daily efforts on A/R management and oversight.
Additionally, this person works with partner departments to problem solve issues and streamline processes.
The OP Senior Coder is also required to mentor other team members and also prepare them for the role of OP Senior Coder.
The OP Senior Coder possesses a strong level of OP clinical coding expertise, and has the ability to handle multiple priorities.
This position requires strong ICD-10, CPT and PCS coding skills, in addition to being able to perform QA reviews, educate and mentor team members, and identify, monitor, trend and resolve issues via dashboards to manage the AR.
EEO/AA/Disability/Veteran
Responsibilities
1.
Manages in collaboration with the OP Coding Leadership team the day-to-day activities related to Outpatient Coding AR to ensure accuracy, completeness, and timeliness of coding completion.
This includes, but is not limited to: ongoing communication and collaboration with internal and partner departments to resolve outstanding issues and streamline workflows, monitoring internal waiting accounts for appropriate coding status application and follow-up and working with team members to resolve issues, monitoring internal volumes and coding capacity to meet goals and making changes and /or recommendations as appropriate, coding cases and resolving coding claims edits to adhere to billing deadline, and drafting compliant OP clinical queries.
2.
Serves as a subject matter expert in OP coding and existing workflows to staff and partner departments.
3.
Responsible to conduct regular QA reviews to identify coding errors and trends , communicate findings, and monitor cases for improvement.
Works closely with OP training and education team on findings and/or trends.
May work with audit educator to educate and train internal staff .
4.
Capable of coding all OP service lines and maintains a minimum of 95% overall coding quality score in diagnostic, procedural, and modifier code selection.
May need to production code based on department needs, and codes cases on a regular basis to reduce outstanding AR.
5.
Participates and seeks out career development activities by reading journals, coding articles, researching procedures and/or disease processes to ensure appropriate code selection, regularly attends coding education sessions, and leads learning circles.
Shares information with team members, and works in conjunction with audit educators to mentor and provide coding support.
6.
Prioritizes coding workload appropriately by focusing efforts on cases and service lines with the potential to impact department goals.
Mentors and provides guidance to fellow team members on prioritizing their coding workload, when needed, to improve AR.
7.
May serve in a lead capacity to provide support to the staff in absence of their supervisor.
8.
Works closely with the OP Vendor Relations Coordinator and this position provides coverage support, as needed.
This includes, but is not limited to: being familiar with processes in place for the vendors, points of contact, tracking, etc.
9.
Performs all other duties or special projects requested by manager.
10.
Exhibits enthusiasm for the profession, rembraces educational opportunities and department support offered and remains engaged in the goals and vision of the department.
Role models the professional standards of behavior and encourages staff to do the same.
Qualifications
EDUCATION Bachelor degree preferred in a health related field.
Required coursework, preferably college level, in anatomy and physiology, medical terminology, pathophysiology, and disease process.
RHIT or RHIA preferred.
EXPERIENCE Five (5) or more years of progressive coding experience in Outpatient Coding.
Must be fully proficient in all OP service lines, which includes ancillary/radiology, ED/Observation, SDS, Oncology, infusion and injection coding, IR and Cardiology, and all current OP workflows.
Prior experience in Epic and 3M required.
Must have working knowledge in resolving coding claim edits, and general understanding of the revenue cycle.
Audit educator and /or coding support experience strongly preferred.
LICENSURE A coding credential from Ahima or AAPC (COC, CIC, CCS, etc.) or Ahima's RHIA or RHIT is required for this position.
Additional specialized coding certifications helpful but not required.
SPECIAL SKILLS Must have extensive knowledge of all service lines within OP coding, includes all official coding guidelines and internal workflows.
Must be able to resolve coding claim edits and have a general understanding of the revenue cycle.
Advanced knowledge of Excel is required, for the ability to track, trend, and report.
Must be able to create dashboards, presentations, educational coding tools and procedures with the use technology and /or reporting to ensure coding compliance, proficiency and adherence to DNFB/DNFC targets.
