Outpatient Coder

Review clinical documentation and diagnostic results to assign appropriate ICD-10-CM and/or CPT codes for billing, internal and external reporting, research, and regulatory compliance. This role works under the direction of the HIM Coding Manager and supports reimbursement accuracy, regulatory adherence, and charge capture improvement.

Responsibilities

• Abide by AHIMA Standards of Ethical Coding and official coding guidelines.
• Review provider documentation to assign diagnoses and surgical procedure or treatment codes using ICD-10-CM and CPT.
• Meet departmental productivity and accuracy expectations.
• Use Care Connect, UDS, and Clintegrity systems to obtain coding information.
• Apply APC/E-APG reimbursement expertise to support accurate coding and reimbursement.
• Formulate compliant coding queries when documentation is incomplete, ambiguous, or unclear.
• Enter and update data accurately in departmental systems.
• Provide support to physicians and clinical quality staff regarding documentation, reimbursement issues, and quality improvement.
• Assign discharge disposition and modifiers as appropriate.
• Analyze documentation to determine charge capture requirements.
• Review reports and queues to identify targeted accounts and coordinate with the CDM team.
• Correct failed claim errors, billing edits, misclassified accounts, and other audit findings.
• Attend required meetings and training sessions.
• Ensure timely reporting for external regulations.