Medical Coding Specialist - Outpatient

Reviews medical reports and physician documentation for clinic and hospital outpatient services to assign diagnostic and procedural codes for claims processing, data retrieval, and analysis.

Primary focus includes Emergency Department and Urgent Care coding, with additional support for other outpatient coding areas.

Technical responsibilities

• Assign ICD and CPT codes for ambulatory outpatient services, including facility and professional services.
• Perform professional code entry for Emergency Room and Urgent Care providers.
• Audit the electronic medical record for accurate patient information, insurance information, diagnosis, and procedure codes.
• Review and resolve NCCI and Outpatient Code Editor (OCE) edits.
• Communicate with clinical department directors and medical billing staff to clarify coding guidelines and resolve claim edits.
• Identify missed revenue opportunities and work with business analysts to create new charge codes as needed.
• Investigate denied claims and submit timely appeals to support accurate reimbursement.
• Abstract pertinent information from patient records using the hospital information system.
• Query physicians for documentation clarification or code assignment support.
• Identify coding concerns and trends and involve Revenue Cycle leadership as needed.
• Provide education on coding changes.
• Attend continuing education and review other resources to maintain coding knowledge and certification requirements.
• Assist with developing coding-related policies and procedures.
• Assist in training new employees and job shadowing.
• Perform other related duties as assigned.