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 (APC’s) and statistical reporting.
Responsible for monitoring the outpatient APC reimbursement for all of the facilities in the Tampa Bay Region.
Monitoring and resolving APC edits to ensure all facilities are receiving accurate reimbursement under Medicare APC regulations.
APC Coordinator will also assist with monthly quality reviews, RAC reviews, and ADR reviews.
Will routinely monitor the Federal Register and other sources for information pertaining to APCs and outpatient payment reform.
Monitors the Internet and applicable list-servs for information and developments concerning APCs and other APC-Type Payment Systems.
Responsible for training outpatient coders on the resolution of APC edits.
APC Coordinator will work with the ancillary departments, and members of the Revenue Cycle Team in order to resolve accounts not selected for billing due to APC edits.
Will participate in the education of Ancillary departments in proper charging so all facilities are in accordance with the National Coding Corrective Initiative.
The APC Coordinator is responsible for the supervision of the outpatient Coder Analysts I and II.
The managing of the outpatient coding queues, training of outpatient coders, and the education of APC edits.
The APC Coordinator will perform in house audits on accounts for all facilities in the Tampa Bay Region.
Occasionally trains others, as in orientation of new employees or acting as a preceptor for workers learning new skills
Occasional contact with physicians and their office staff.
Occasional contact with CDIS team.
Communicates to various departments when charges need added, deleted, or changed and when discharge dispositions and patient type/status needs clarified.
Professional demeanor, patience, and tact required in dealing with any and all staff within the department, the facility, and outside influences
Requires maintenance of confidential information encountered in every task associated with this job
Requires compliance with department Coding Policy and Procedure manual and Coding Clinic guidelines, as well as, any governmental coding regulations.
Requires coding knowledge of all specialties for multi-hospital coding.
Codes all the diagnosis, treatments and procedures for inpatient records in accordance to departmental policies and procedures.
Abstracts all inpatient, outpatient surgery and procedure charts Verifies CAC codes and/or assigns diagnosis and procedure codes following ICD-9 coding principles, CPT Assistant, Coding Clinic guidelines and Department coding policies and procedures manual.
Verifies principal diagnosis assigned by physician or coder, verifies and agrees with diagnostic and procedure codes selected via Computer Assisted Coding (CAC), and Uniform Hospital Discharge Data Set definition of principle diagnosis.
Verifies CAC codes and/or assigns diagnosis and procedure codes based on physician documentation in the record supporting assigned diagnoses.
Assist physicians and other clinicians with questions regarding DRG, coding, and prospective payment requirements and guidelines.
Reviews and/or verifies diagnostic information as entered into JA Thomas by the CDIS (Clinical Documentation Specialists),
Reviews assigned charges in the charge viewer to verify what is ordered and what procedures are carried out.
Informs the Coding Management Team of any coding or coding related issues that adversely impact the claims processing, coding accuracy, and compliance.
Monitors the status of the unbilled reports, and resolves CCTs timely to help manage the timely filing of unbilled accounts
Consistently maintains productivity and accuracy standards as outlined by the Director of Coding.
Reviews and Correct charges on surgical accounts, makes changes as appropriate.
Demonstrates attention to detail, thoroughness and accuracy in daily work.
Completes high quality work in accordance with outlined standards and procedures within defined timeframes.
Prepares workload reports and managerial support data as needed.
Works with other Coding team members to keep coding within the four (4) day cooling off period.
Completes coding for multiple facilities in a timely manner
Works with other coding team members to maintain ANSB days to less than 0.75 days after cooling off period.
Works closely with the CDIS (Clinical Documentation Specialists) for clear, complete documentation for all Medicare records entered into JA Thomas software.
Participates in department performance improvement reviews and coding reviews.
Meets and Maintains productivity standards
Meets and maintains a 95% or better in coding accuracy
Demonstrates initiative in providing patients/customer service and resolving problems.
Sets priorities and demonstrates effective organizational skills by optimizing use of time, meeting deadlines, and completing assigned tasks in a cost-responsible manner.
Using the computerized system, prepares reports
Improves skills through continued education and training.
Successfully meets requirements to code all patient types
Successfully completes all sections of the ICD-10 training via AHIMA
What will you need?
Knowledge of all acute care hospital outpatient coding (ED, ancillary, Observation, and Same Day Surgery coding).
Knowledge of Official Coding Guidelines.
Must be able to score a minimum of 75% on coding test, given during interview process.
Good computer skills with the ability to learn Cerner and Optum Encoder.
Ability to review documentation in a medical record and to enter into the coding software.
High School diploma, and completion of an AHIMA or CAHIIM certified coding program.
Applicants with outpatient coding and OCE edit experience will be considered if applicant demonstrates a 75% or higher on a coding/OCE edit proficiency test.
Outpatient coding experience to include ED, Ancillary, Observation, and Surgery coding.
Candidate should be knowledgeable in the resolution of OCE edits and HCPCS codes.
All candidates must be able to pass a Coding proficiency/OCE edit test with 75% or above.
RHIA, RHIT, or CCS; Must obtain within 2 years of hire (Preferred)
Associate degree in Medical Record Technology/ Health Information Management and or completion of Coding certificate program from an AHIMA or CAHIIM accredited school. (Preferred)
2-5 years Outpatient coding experience, as well as experience with HCPCS codes, and the resolution of OCE and clinical edits. (Preferred)
Knowledgeable in the resolution of OCE edits, and able to code all acute care outpatient patient types. (Preferred)
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