Job Summary
The Outpatient Coder is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes for outpatient services, including emergency department visits, outpatient surgeries, observation stays, interventional radiology, wound care, and ancillary procedures. This role ensures compliance with coding guidelines, regulatory requirements, and corporate billing policies, while contributing to accurate reimbursement and data integrity. The Outpatient Coder reviews medical records and applies appropriate codes within hospital coding systems.
Essential Functions
Reviews and assigns appropriate ICD-10-CM, CPT, and HCPCS codes for outpatient records, ensuring compliance with coding and billing regulations.
Codes a variety of outpatient encounters, including observation stays, outpatient surgeries, interventional radiology, cardiac catheterization, emergency department visits, wound care, and ancillary services.
Applies correct coding guidelines and payer-specific policies, ensuring adherence to LCD/NCD (Local Coverage Determination/National Coverage Determination) requirements.
Resolves coding edits and denials, identifying and correcting discrepancies while maintaining compliance with corporate and regulatory standards.
Maintains coding productivity and accuracy standards, achieving a 95% coding accuracy rate and meeting corporate benchmarks.
Consults with the Manager or other subject matter experts to resolve complex coding issues and discrepancies.
Collaborates with Clinical Documentation Integrity (CDI) specialists and billing teams, ensuring complete and accurate coding and documentation.
Ensures adherence to HIPAA privacy and security standards, maintaining confidentiality of patient records.
Utilizes hospital coding software and related tools to ensure accuracy and compliance with corporate policies.
Performs other duties as assigned.
Maintains regular and reliable attendance.
Complies with all policies and standards.
Qualifications
- H.S. Diploma or GED required
- Associate Degree in Health Information Management, Medical Coding, or a related field preferred or
- One (1) year coding certification in Health Information Management preferred
- 1-3 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 electronic health record (EHR) systems and coding software (e.g., 3M, Meditech, Epic, 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, with the ability to collaborate with CDI teams and billing departments.
- Knowledge of HIPAA regulations and patient privacy standards.
- Licenses and Certifications
- Certified Coding Specialist (CCS) – AHIMA required or
- CCA - Certified Coding Associate required or
- Certified Outpatient Coder (COC) – AAPC required
- RHIA - Registered Health Information Administrator preferred or
- RHIT - Registered Health Information Technician preferred
