Gaffney, South Carolina
Gainesville, Georgia
Durham, North Carolina
Easton, Maryland
Posted: 15-Dec-24
Location: Maitland, Florida
Categories:
Internal Number: 24043790
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Career Development
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full Time Virtual
Shift: Day
The community you’ll be caring for:
Location: 601 E. Rollins St., Orlando, FL 32801
· Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando
· serves as the major tertiary facility for much of the Southeast, the Caribbean and South America
· AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country
· We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year
The role you’ll contribute:
The Ambulatory Payment Classification (APC) Coordinator is responsible for assigning, monitoring, and evaluating the assignment of CPT and HCPCS Level II procedure codes for grouping into Ambulatory Payment Classifications (APCs) and statistical reporting. Responsible for monitoring the outpatient APC reimbursement for all AdventHealth Central Florida South Division facilities. Monitoring and resolving APC edits to ensure all facilities are receiving accurate reimbursement under OPPS. The APC Coordinator may assist with monthly quality reviews, RAC, and post-payment audits. Will routinely monitor the Federal Register and other sources of regulatory information to ensure the team is up to date on the latest Coding and payment updates. The APC Coordinator may assist in training outpatient coders on the appropriate resolution of NCCI edits. Work alongside members of the ancillary departments and revenue cycle team to obtain a timely resolution of accounts discharged but not final billed and ensure we are billing clean claims. The APC Coordinator will assist in overseeing the outpatient coding queues, training, and education.
The expertise and experiences you’ll need to succeed:
Minimum Qualifications:
LICENSURE, CERTIFICATION, OR REGISTRATION REQUIRED:
· RHIA, RHIT, CPC, or CCS certification.
EDUCATION AND EXPERIENCE REQUIRED:
1. Minimum of three (3) years of proven outpatient coding experience
KNOWLEDGE AND SKILLS REQUIRED:
1. Excellent communication skills
2. Progressive professional growth
3. Exhaustive knowledge of outpatient coding and working knowledge of ICD-10-CM, CPT, NCCI edits, and all regulatory compliance requirements.
The value you’ll bring to the team:
RESPONSIBILITIES:
1. Establishes and maintains courteous, tactful, and professional interpersonal skills necessary to deal effectively with patients, guests, medical staff, the public, co-workers, and external business associates.
2. Demonstrates effective communication skills; can report and convey required information either verbally or in writing; maintains the required level of confidentiality; consults with and/or advises appropriate personnel of situations requiring follow-up or attention.
3. Conforms to all Adventist Health Systems organizational and departmental policies and procedures, including but not limited to:
a. Mission
b. Values/Service Standards
c. Employee covenant
d. Corporate Compliance
e. Rules of conduct as outlined in the “Guidelines for Employees” handbook.
f. Smoking
g. Dress code
4. Establishes and maintains a history of regular attendance; appropriately uses PDO and
observes department call-in procedures for absence; establishes and maintains punctual work
habits. Exhibits timely arrival and departure and dependable time habits, including meals and
other breaks.
6. Supports departmental and organizational Mission through:
a. Appropriate use of resources
b. Helping team members
c. Accepting work or schedule assignments
d. Participating in process and performance improvement as required
- Assists with developing and implementing strategies and procedures to reduce denials, maximize reimbursements, and promote faster payment.
- Resolves claim edits within the EPIC management billing system to ensure successful claim submission.
- Monitor payer rejects and denials to determine systemic or data entry issues and report irregularities to management.
- Maintains knowledge of third-party payor reimbursement guidelines and managed care contracts.
- Responsible for receiving and addressing accounts within 72 hours of being routed to the claims edit work queue and coding review needed work queue.
7. Combine inpatient and outpatient accounts according to EPIC and payer-specific guidelines.
8. Builds relationships with ancillary departments, revenue integrity, and patient financial services to work on the timely resolution of accounts with claim edit rejections.
9. Reviews and addresses all third-party/Regulatory Agencies’ requests for APC changes or quality studies.
10. Codes and abstract charts in accordance with ICD-10-CM conventions, applying coding rules applicable to AdventHealth Central Florida South Division and requirements of Medicare and payor specifications.
11. Maintains a 110% productivity rate.
12. Assists manager in maintaining goals for accounts discharged not final billed (DNFB).
13. Assists in reviewing and correcting any information for the Agency for Healthcare Administration (AHCA).
14. Reports non-compliance issues detected through auditing and monitoring to the manager.
15. Keeps abreast of coding guidelines and reimbursement reporting requirements and brings identified concerns to the manager for resolution.
16. Maintains a current knowledge of ICD-10-CM/CPT coding updates and changes through Coding Clinics, seminars, and Medicare/Insurance industry changes.
17. Uses the 3M and Dolbey CAC coding software, ICD-10-CM code books, CPA Assistant and Coding Clinics sources per established coding principles and guidelines.
18. Attends meetings as required.
19. Other duties as assigned.
