Single Path Coding Specialist II

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This is a Stanford Health Care job.

A Brief Overview
The Single Path Coding (SPC) Specialist-Level 2 is an advanced coder position responsible for reviewing clinical documentation to extract data and assign appropriate International Classification of Diseases 10th Edition Clinical Modification (ICD-10-CM) diagnostic codes, Current Procedural Terminology (CPT) procedure codes and modifiers, group Ambulatory Payment Classifications (APCs) for billing, and process National Correct Coding Initiative (NCCI) and payer specific edits related to hospital and professional coding. The Single Path Coder processes codes for surgical encounters and follows the ICD-10-CM Official Guidelines for Coding and Reporting, the American Health Information Management Association (AHIMA) Code of Ethics and Standards of Ethical Coding, as well as all American Hospital Association (AHA) Coding Clinics for HCPCS and the American Medical Association (AMA) CPT Assistant.

The SPC Coding Specialist II serves as a subject matter expert in hospital and professional coding, and interacts with other teams and departments across the organization such as Patient Financial Services, the Patient Billing Office, the Revenue Integrity (Charge Description Master) Team, provider teams and/or Compliance on a routine basis. Additionally, this position interacts with physicians, DFA's, clinical mangers and many other clinical roles throughout the enterprise. The SPC Coding Specialist follows Stanford Health Care policies and procedures and maintains required quality and productivity standards while remaining compliant with third party, State and Federal regulations. In addition to traditional coding related activities, responsibilities also include reviewing and resolving medical necessity edits that may apply for any outpatient surgical encounters, applying hospital and professional modifiers to CPT codes, processing any errors associated with the revenue cycle process, and collaborates on summarizing findings for provider documentation optimization opportunities. When necessary, the SPC Coding Specialist may assist in the design and implementation of workflow changes to reduce coding and billing errors.

The SPC Coding Specialist II is distinguished from SPC Coding Specialist I by mastering more than one specialty and/or possessing coding certification in two specialties.

Locations

Stanford Health Care

What you will do

• Reviews medical record documentation and accurately assigns appropriate ICD-10-CM diagnoses, CPT codes and modifiers as applicable for both the hospital and professional claim

• Validate and process any medical necessity edits (local or national coverage determinations) that may apply for hospital and professional coding

• Process coding-related payer specific edits for the hospital and professional claim

• Communicates effectively with provider teams across the organization; serve as an advocate for documentation improvement

• Follow established coding conventions and guidelines as set forth by State and Federal regulations

• Responsible for monitoring Discharged Not Billed accounts, and as a team, ensure timely, compliant processing of outpatient and inpatient encounters through the hospital and professional revenue cycle

• Responsible for maintaining established quality and productivity standards

• Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision

• Exhibits strong time management, problem solving and communication skills

• Critical thinking, good judgment and decision making skills

• Excellent written and oral communication skills

• Remain abreast of current Centers for Medicare and Medicaid Services (CMS) requirements, NCCI edits, National Coverage Determinations (NCDs), Local Coverage Determinations (LCDs), payer specific edit processing required to ensure clean claim submission for both the hospital and professional

• Follows all established Stanford Health Care policies and procedures

• Attends required system, hospital and departmental meetings and educational sessions as established by leadership, as well as completion of required annual learning programs, to ensure continued education and growth

• Employees must abide by all Joint Commission requirements including, but not limited to, sensitivity to cultural diversity, patient care, patients’ rights and ethical treatment, safety and security of physical environments, emergency management, teamwork, respect for others, participation in ongoing education and training, communication and adherence to safety and quality programs, sustaining compliance with National Patient Safety Goals, and licensure and health screenings

• Employees must perform all duties and responsibilities in accordance with the C-I-CARE Standards of the Hospital. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions

Education Qualifications

• Associate Degree in work -related discipline/field or equivalent combination of education and work experience

Experience Qualifications

• Five years; must be proficient in coding surgical encounter specialties

• Currently holds role-related certifications RHIA, RHIT, CCS, CCS-P, CPC, or COC or other coding certification in specialized area OR CIRCC for advanced knowledge of Interventional Radiology and Interventional Cardiology coding

Required Knowledge, Skills and Abilities

• Successful completion of the Coder Proficiency Exam (pre-hire)

• Ability to consistently meet department’s quality and productivity standards

• Ability to develop and maintain supportive, collaborative relationship with Physicians and other clinical professionals

• Ability to adapt to and deal with change and ambiguity

• Ability to plan, organize, prioritize, work independently and meet deadlines

• Ability to comply with the American Health Information Management Association’s Code of Ethics and Standards

• Ability to establish and maintain effective working relationships

• Ability to manage, organize, prioritize, multi-task and adapt to changing priorities

• Ability to solve technical and non-technical problems

• Ability to utilize the ICD-10-CM/PCS and CPT-4 coding conventions to code medical record entries; abstract information from medical records; read medical record documentation

• Ability to work effectively through and with others

• Knowledge of APC grouping methodology

• Knowledge of health information systems for medical records (Epic and 3M 360e Computer Assisted Coding)

• Ability to foster effective working relationships and build consensus

• Ability to work effectively with individuals at all levels of the organization

• Knowledge of NCCI and other CMS compliance issues

• Knowledge of standards and regulations pertaining to the maintenance of patient medical records; medical records coding systems; medical terminology; anatomy and physiology and disease processes

Licenses and Certifications

• RHIA - Registered Health Information Administrator or

• RHIT - Registered Health Information Technician or

• CCS - Certified Coding Specialist or

• CPC and/or CCSP - Certified Professional Coder or

• COC

Physical Demands and Work Conditions
Blood Borne Pathogens

• Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks

These principles apply to ALL employees:

SHC Commitment to Providing an Exceptional Patient & Family Experience

Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery.

You will do this by executing against our three experience pillars, from the patient and family’s perspective:

• Know Me: Anticipate my needs and status to deliver effective care

• Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health

• Coordinate for Me: Own the complexity of my care through coordination

Equal Opportunity Employer Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination inall ofits policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.

The salary of the finalist selected for this role will be set based on a variety of factors, including but not limited to, internal equity, experience, education, specialty and training. This pay scale is not a promise of a particular wage.