Accurately assigns coding for outpatient and ambulatory emergency room encounters using medical record documentation. Codes may include E&M, ICD-CM diagnoses, ICD-10-PCS, CPT, HCPCS, modifiers, and quantities for both professional and facility components.
Reviews encounter and record documentation to identify inconsistencies, ambiguities, or discrepancies that could lead to inaccurate coding or affect patient care quality.
Identifies documentation issues such as legibility concerns or unclear abbreviations and brings them to the provider's attention.
Educates providers and clinical staff on documentation issues to support compliant and accurate coding.
Assigns codes based on provider responses to coding queries and serves as a coding reference for medical staff.
Collaborates with coding auditors, trainers, and CDI specialists to support education and feedback efforts.
Researches and interprets coding guidance appropriately to support compliance.
Uses computer systems to remotely access patient records and assign codes as directed by coding supervisors.
Maintains productivity and accuracy standards for the position.
Minimum Qualifications
- One of the following recognized professional coding certifications:
- Certified Coding Specialist (CCS)
- Certified Professional Coder (CPC)
- Registered Health Information Technician (RHIT)
- Registered Health Information Administrator (RHIA)
- Certified Coding Specialist – Physician (CCS-P)
- Preferred certifications include:
- Certified Evaluation and Management Coder (CEMC)
- NAMAS Certified Evaluation and Management Auditor (CEMA)
- Knowledge of evaluation and management (E&M), ICD-CM, ICD-10-PCS, CPT, HCPCS, modifiers, and outpatient coding workflows
Location
Florida, US
Employment Type
Full-time
Experience Level
Associate
Remote work allowed
Yes
Posted
3 weeks ago