The Outpatient Coder-Edits role is responsible for reviewing and resolving outpatient coding alerts and edits related to observation and surgical services. The position ensures timely billing and reimbursement by identifying issues that prevent claims from being processed and by making accurate ICD-10-CM, CPT, and HCPCS code assignments in alignment with compliant coding standards and corporate policies.
Key responsibilities include:
- Review and resolve moderate to high-complexity outpatient coding edits and errors.
- Apply ICD-10-CM, CPT, and HCPCS coding rules, including handling missing or incorrect modifiers, CCI edits, and payer medical necessity denials.
- Work in the Bill Scrubber System (SSI) as needed.
- Enter root-cause data in Fluency Time Capture to support process improvement.
- Participate in scheduled coding education.
- Support special projects and other assigned duties.
- Maintain productivity standards while achieving at least 95% coding accuracy.
- May assist with work typically performed by lower-level coding edit resolution staff.
Requirements & Qualifications
Qualifications
- High school diploma or GED required.
- Associate degree in Health Information Management, Medical Coding, or a related field preferred.
- One-year coding certification in Health Information Management preferred.
- 3 years of outpatient coding experience in an acute care hospital or healthcare system required.
- Experience coding emergency department visits, outpatient procedures, interventional radiology, and/or ambulatory surgery preferred.
Knowledge, Skills, and Abilities
- Strong knowledge of ICD-10-CM, CPT, and HCPCS coding principles and outpatient reimbursement methodologies.
- Understanding of Local Coverage Determination (LCD), National Coverage Determination (NCD), and payer-specific coding guidelines.
- Experience with EHR systems and coding software such as 3M, Meditech, Epic, or Cerner.
- Ability to analyze and resolve coding edits, rejections, and denials efficiently.
- Strong attention to detail and organizational skills.
- Excellent communication and problem-solving skills.
- Ability to collaborate with CDI teams and billing departments.
- Knowledge of HIPAA regulations and patient privacy standards.
Licenses and Certifications
- Certified Coding Specialist (CCS) required, or
- CCA - Certified Coding Associate required, or
- Certified Outpatient Coder (COC) required.
- RHIA or RHIT preferred.
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
No
Posted
1 month ago
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