The Certified Outpatient Coder will join an emerging coding team within the billing and credentialing service. This role reviews ambulatory medical records for multi-specialty provider organizations to ensure billed codes are supported by clinical documentation. The coder interprets medical record data for payer processing and ensures coding compliance with applicable guidelines.
Responsibilities
- Assign diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other information
- Complete coding in a timely manner to meet billing deadlines
- Help resolve 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 stream and report them to management
- Stay current on coding and documentation guidelines, compliance policies, annual coding updates, payer policies, and industry changes
- Perform other duties as assigned
Requirements & Qualifications
Required Qualifications
- High School Diploma or equivalent required
- CPC certification required
- 3-5 years of CPT/HCPCS outpatient coding experience, preferably in a multi-specialty facility
- Knowledge of ICD-CM, CPT, HCPCS, and CCI edits
- Understanding of third-party payer requirements, federal and state guidelines, and medical coding/billing regulations
- Knowledge of current ICD-10-CM and CPT/HCPCS official coding guidelines
- Knowledge of medical record content and management
- Working knowledge of EMR systems
- Medical terminology knowledge
- Knowledge of health information laws and patient confidentiality requirements
- Proficiency with Microsoft Office applications such as Excel, Word, and PowerPoint
- Strong interpersonal and communication skills
- Ability to work accurately, efficiently, and on time
- Ability to learn new software and systems
- Ability to identify problems, determine causes, and develop solutions
- Ability to persevere in difficult situations
- Must be able to remain in a stationary position 50-75% of the time
Preferred Qualifications
- Familiarity with the MassHealth ACO program
- Familiarity with Federally Qualified Health Centers
- Prior Epic experience highly preferred
Location
Boston, Massachusetts, US
Employment Type
Full-time
Experience Level
Intermediate Level
Salary Range
$50,217 - $57,749
Remote work allowed
Yes
Posted
1 week ago