Ocean Health Executives is seeking an experienced and highly motivated Facility Outpatient Clinic Coder to support hospital-based outpatient clinic coding operations.
This role is responsible for accurate assignment of ICD-10-CM, CPT, HCPCS, and facility Evaluation & Management (E&M) levels for hospital outpatient clinic encounters while ensuring compliant reimbursement and adherence to payer and regulatory guidelines.
Responsibilities
- Review and code hospital-based outpatient clinic encounters accurately and efficiently
- Assign ICD-10-CM diagnosis codes, CPT procedure codes, HCPCS Level II codes, and applicable modifiers based on provider documentation and coding guidelines
- Review clinical documentation and assign appropriate facility E&M levels for outpatient clinic encounters in accordance with organizational guidelines, CMS regulations, payer requirements, and facility charging methodologies
- Validate supporting documentation for facility E&M level assignment, including nursing interventions, resource utilization, treatment intensity, and ancillary services provided during the encounter
- Ensure compliant application of facility-specific E&M leveling criteria and identify documentation opportunities impacting charge capture and reimbursement
- Ensure appropriate facility charging and outpatient reimbursement compliance
- Review documentation for medical necessity, completeness, and coding specificity
- Identify documentation deficiencies and communicate clarification opportunities when appropriate
- Maintain productivity and quality standards established by the organization and client
- Work assigned coding work queues and resolve coding edits as needed
- Collaborate with revenue cycle, CDI, compliance, and operational teams to resolve coding and billing issues
- Stay current with coding updates, payer requirements, and regulatory changes affecting outpatient facility services
- Participate in quality assurance reviews and educational initiatives
Requirements & Qualifications
Qualifications
- Minimum 3 years of outpatient facility coding experience required
- Experience assigning hospital outpatient facility E&M levels required or strongly preferred
- Strong knowledge of:
- Hospital outpatient facility coding
- Facility E&M leveling methodologies
- CPT and HCPCS coding guidelines
- ICD-10-CM diagnosis coding
- Modifier assignment and outpatient reimbursement methodologies
- CMS and payer regulatory requirements
- Charge capture workflows and documentation review
- Experience coding one or more of the following preferred:
- Hospital-based clinics
- Multi-specialty outpatient clinics
- Observation services
- Same-day surgery (SDS)
- Emergency Department
- Ancillary services
- Familiarity with Epic or other EMR systems preferred
- Strong attention to detail and critical thinking skills
- Ability to work independently in a remote production environment
- Excellent communication and organizational skills
Required Credentials
- AHIMA Certified Coding Specialist (CCS)
- AHIMA Registered Health Information Administrator (RHIA)
- AHIMA Registered Health Information Technician (RHIT)
- AAPC Certified Professional Coder (CPC)
Preferred Experience
- Facility outpatient coding
- Hospital outpatient reimbursement methodologies
- Medical necessity and charge review processes
- Denial resolution and edit work queues
- Remote coding production environments
Benefits & Perks
Benefits
- Flexible schedule
Location
N/A
Employment Type
Full-time
Experience Level
Intermediate Level
Remote work allowed
Yes
Posted
1 month ago
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