Outpatient/Provider Coder III

Overview

As a patient-focused organization, University of Utah Health exists to enhance the health and well-being of people through patient care, research and education. Success in this mission requires a culture of collaboration, excellence, leadership, and respect. University of Utah Health seeks staff that are committed to the values of compassion, collaboration, innovation, responsibility, integrity, quality and trust that are integral to our mission. EO/AA

This position is responsible for 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 charges complex or specialty services and may serve as a resource for other coders. This position is not responsible for providing care to patients.

Corporate Overview: The University of Utah is a Level 1 Trauma Center and is nationally ranked and recognized for our academic research, quality standards and overall patient experience. Our five hospitals and eleven clinics provide excellence in our comprehensive services, medical advancement, and overall patient outcomes.

Responsibilities

Essential Functions

• Performs the final reconciliation on clinic or provider visits and resolves missing, incomplete, or inconsistent documentation by contacting appropriate personnel.
• Reviews, abstracts, and codes multiple or sub specialty services and complex or unusual cases, and assigns appropriate coding classifications.
• 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.
• 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.
• Researches, interprets, and applies regulatory guidelines to coding and reimbursement decisions and educates staff on associated guidelines and resolutions.
• Assists in the auditing process.
• Trains levels I and II coders and may serve as a project lead.
• Assists with backlog to maintain department quality and productivity standards.
• Assists with other department coding needs, as requested.
• May participate on committees and work groups.
• May formally present information to providers and assist in training efforts regarding coding and billing.

Knowledge / Skills / Abilities

• Demonstrated potential ability to perform the essential functions as outlined above.

• Demonstrated leadership, human relations and effective communication skills.

• Demonstrated knowledge of clinical documentation requirements related to regulatory and reimbursement rules and regulations, and health insurance processing.

• Demonstrated proficiency in computer software. (e.g. Microsoft Word and Excel).

• Ability to maintain certifications through continuing education credits.

• Ability to effectively train others.

• Knowledge of CMS, AMA, and AHA coding and billing guidelines.

Qualifications

Required

• American Health Information Management Association (AHIMA) or American Academy of Professional Coders (AAPC) recognized certification such as: Certified Coding Associate (CCA), Certified Professional Coder (CPC), Certified Outpatient Coder (COC), 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.
• Three years of coding, clinical or billing experience.

Qualifications (Preferred)

Preferred

• Experience in organizing and conducting coding or billing education.

Working Conditions and Physical Demands

Employee must be able to meet the following requirements with or without an accommodation.

• This is a sedentary position that may exert up to 10 pounds and may lift, carry, push, pull or otherwise move objects. This position involves sitting most of the time and is not exposed to adverse environmental conditions.

Physical Requirements