Coding Account Resolution Specialist-Outpatient

About This Role

The Coding Account Resolution Specialist-Outpatient resolves outpatient coding related alerts and edits, primarily for Same Day Surgery, Observation, and Wound Care accounts. This role ensures timely correction of coding errors according to established procedures and collaborates with various teams to minimize billing delays.

Responsibilities

• Compile daily work list from eRequest, CRT, and other alert/edit systems.
• Resolve alerts/edits for Same Day Surgery (SDC), Observation (OBV), Wound Care, and Outpatient Cardiac Cath patient types.
• Enter detailed notes in eRequest for unresolved alerts/edits or those requiring rerouting.
• Escalate alert/edit resolution issues to minimize final billing delays.
• Monitor aging of accounts held by alerts/edits, prioritize aged accounts, and report to leadership.
• Collaborate with billing, revenue integrity, and Medicare Service Center teams to resolve alerts/edits.
• Communicate coding revisions to relevant parties (e.g., CIS, lead, manager, international log).
• Complete MOCK abstracts as necessary, such as combining codes for outpatient claims subject to payment window.
• Assist Coding Leads and/or Coding Managers in resolving unbilled reason codes (URC)/Hold Reasons.
• 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/medical resources to maintain current coding knowledge.

Requirements

• One year of 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

• High School graduate or GED equivalent
• Associate's or Bachelor's degree in HIM/HIT
• RHIA certification
• RHIT certification
• CCS certification

Benefits