Single Path Coding Specialist II

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Day - 08 Hour (United States of America)

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

• Empl