Coding Account Resolution Specialist - Outpatient

About This Role

The Coding Account Resolution Specialist-Outpatient works to resolve outpatient coding-related alerts and edits for various patient account types, ensuring high-quality, efficient care. This role involves independently managing a daily work list, prioritizing aged accounts, and collaborating with cross-functional teams to resolve issues promptly.

Responsibilities

• Compile daily work list from eRequest, CRT, and/or other alert/edit systems
• Take action and resolve alerts/edits for Same Day Surgery (SDC), Observation (OBV), Wound Care, and Outpatient Cardiac Cath patient types
• Enter detailed notes to update eRequest for unresolved or rerouted alerts/edits
• Escalate alert/edit resolution issues as appropriate to minimize final billing delays
• Monitor the aging of accounts held by an alert/edit, prioritize aged accounts, and report to leadership
• Work with team members in billing, revenue integrity, and/or the Medicare Service Center to resolve alerts/edits
• Communicate coding revisions to applicable parties (e.g., CIS, lead, manager, international log)
• Complete MOCK abstracts as necessary (e.g., combining codes for outpatient claims subject to payment window)
• Assist Coding Leads and/or Coding Managers in resolving unbilled reason codes (URC)/Hold Reasons
• Periodically review individual work accomplishments, discuss work problems/barriers, and training needs with Manager
• Adhere to all applicable coding and billing regulations and guidance, including CMS, AHA, and HCA policies
• Meet all educational requirements as stated in Company and HSC policy
• Review official data quality standards, coding guidelines, policies, and clinical resources to maintain current coding knowledge

Requirements

• High School graduate or GED equivalent
• One (1) year acute care observation and/or same day surgery hospital outpatient coding experience

Qualifications

• High School graduate or GED equivalent preferred, undergraduate (associates or bachelors) degree in HIM/HIT preferred
• One (1) year acute care observation and/or same day surgery hospital outpatient coding experience required

Nice to Have

• Undergraduate (associates or bachelors) degree in HIM/HIT
• RHIA certification
• RHIT certification
• CCS certification

Benefits

Certifications