Outpatient Coder

Job Description:

• Review ambulatory medical records for multi-specialty provider organizations to ensure billed codes are accurately supported by clinical documentation
• Interpret medical record data into language payers can interpret to process physician charges
• Ensure coding complies with all coding guidelines
• Assign appropriate ICD-10 diagnosis codes and CPT/HCPCS procedure codes based on medical documentation, physician notes, and other information
• Complete coding in a timely manner to meet billing deadlines
• Assist in resolving incomplete or missing documentation to expedite billing
• Communicate with healthcare providers to clarify coding questions and concerns
• Perform claim edit corrections and denial reviews related to coding errors
• Identify coding or documentation trends that may pose a risk to revenue and report them to management
• Stay current with coding and documentation guidelines, compliance policies, annual coding updates, payer policies, and industry changes
• Perform other duties as assigned
• Report to the Director of Revenue Integrity

Requirements:

• High School Diploma or equivalent required
• CPC Certification required
• 3-5 years CPT/HCPC Outpatient coding experience, preferably in a multi-specialty facility
• Knowledge of ICD-CM (current edition), CPT, HCPCS coding systems and CCI edits
• Knowledge of third-party payer requirements, federal and state guidelines and regulations on medical coding and billing
• Knowledge of current ICD-10-CM and CPT/HCPC Official Guidelines for Coding and Reporting
• Knowledge of medical records content and management
• Working knowledge of the EMR through experience or education
• Medical terminology knowledge
• Knowledge of laws and regulations about health information and patient confidentiality
• Proficiency in Microsoft Office applications such as Excel, Word and PowerPoint
• Ability to learn new software and systems
• Must be able to remain in a stationary position 50-75% of the time
• Familiarity with the MassHealth ACO program desired
• Familiarity with Federally Qualified Health Centers desired
• Experience with anti-racism activities and/or lived experience with racism highly preferred
• Prior Epic experience highly preferred