Senior Outpatient Coding Specialist

Responsible for the review and coding of complex outpatient and ambulatory surgery records using ICD-10-CM, ICD-10-PCS, and CPT coding guidelines for the establishment of diagnoses and procedures for both professional and facility insurance claims. Reviews electronic medical health records in eClinicalWorks for completeness and accuracy before release to the outside billing organization. Works closely with the billing organization to troubleshoot and identify the root cause of insurer payment delays, denials, and rejections.

• Assigns CPT, HCPCS, and ICD-10-CM codes and abstracts patient encounters, including diagnostic and procedural information, significant reportable elements, and complications.
• Reviews, audits, analyzes, and interprets the eCW medical record to ensure accurate, complete, and consistent selection of diagnoses and procedures.
• Queries physicians for clarification of documentation as needed.
• Participates in the documentation improvement process with the CFO and executive leadership.
• Reviews and verifies documentation support for existing diagnoses, procedures, and other charges.
• Ensures compliance with CMS and other regulatory guidelines.
• Follows up on open or unlocked provider case files and ensures readiness for billing within 48 to 72 hours of date of service.
• Prepares and reviews final EMHRs for completeness before release to outside billing agents.
• Collaborates with providers, finance, executive leadership, and the revenue cycle process to improve communication and reimbursement.
• Communicates regularly with the outside billing organization to troubleshoot case file issues and claim denials.
• Identifies EMHR software and template modifications to optimize reimbursement and revenue.
• Assists with training and orientation of staff.
• Performs other duties as assigned.