OP Coders analyze clinical documentation; assign appropriate diagnosis, procedure, and, in some cases, levels of service codes; and abstract the codes and other clinical data. Performs a variety of technical functions within the Hospital Outpatient coding area, codes ancillary outpatient visits, home health, hospice, sent-in-labs, consolidated funding accounts, utilizing ICD-10-CM and CPT-4 Coding Classification systems. Utilizes an encoder and computer assisted coding software to code to the highest level of specificity, ensuring optimal and appropriate reimbursement for the services provided. Responsibility includes resolving medical necessity edits, and extracting and entering data into the medical record abstract for a variety of like outpatient visit types similar to those listed above. This information is then used to determine reimbursement levels, assess quality of care, study patterns of illness and injuries, compare healthcare data between facilities and between physicians, and meet regulatory and payer reporting requirements. OP Coding also resolve clinical documentation and charge capture discrepancies, and provide feedback to providers on the quality of their documentation and charging.
Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards.
Actively participates in creating and implementing improvements.
Assigns ICD-10 or CPT codes to all diagnoses, treatments, and procedures, according to official coding guidelines.
Validates computer assisted coding (CAC) generated and suggested codes in conjunction with encoder.
Extracts required information from electronic medical record and enters into encoder and abstracting system.
Follows-up on unabstracted accounts to assure timely billing and reimbursement.
Resolves any questions concerning diagnosis, procedures, clinical content of the chart or code selection through research and communication. May query physicians on documentation according to established procedures and guidelines.
Meets productivity and quality standards as specified by manager.
Review OASIS documentation for accuracy.
Provide on-going learning to staff regarding coding practices.
Complete projects as assigned.
Share payer specific guidelines to ensure correct coding.
Performs other responsibilities as needed/assigned.
Certificate program in coding or associate degree in HIM or a certificate with 1-3 years of healthcare experience (MA, HUC, Revenue Cycle)
No experience required if appropriate coursework has been completed
None if graduate of a program or associate degree, 1-3 years of healthcare experience (MA, HUC, Revenue Cycle) with a certification
Together with the University of Minnesota and University of Minnesota Physicians we have created M Health Fairview. M Health Fairview is the newly expanded collaboration among the University of Minnesota, University of Minnesota Physicians, and Fairview Health Services. The healthcare system combines the best of academic and community medicine — expanding access to world-class, breakthrough care through our 10 hospitals and 60 clinics.
Fairview Health Services (fairview.org) is an award-winning, nonprofit health system providing exceptional care across the full spectrum of health care services. Fairview is one of the most comprehensive and geographically accessible systems in the state, with 10 hospitals—including an academic medical center and long-term care hospital—serving the greater Twin Cities metro area.
Its broad continuum also includes 60 primary care clinics, specialty clinics, senior living communities, retail and specialty pharmacies, pharmacy benefit management services, rehabilitation centers, counseling and home health care services, medical transportation, an integrated provider netwo...rk and health insurer PreferredOne. In partnership with the University of Minnesota, Fairview’s 32,000 employees and 2,400 affiliated providers embrace innovation to drive a healthier future through healing, discovery and education.