Certified Professional Coder

Certified Professional Coder, Outpatient Billing

Full Time Corporate

3 days ago Requisition

Salary Range: $27.00 To $35.00 Hourly

This role is responsible for ensuring accurate, compliant, and complete coding of professional outpatient encounters in a high-volume urgent care environment. This role reviews provider documentation, validates and corrects CPT® and ICD-10-CM code selection, queries providers for missing or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding requirements prior to billing. This role also plays a key role in supporting provider coding and documentation audits and manual coding activities required during system downtime or special operational needs.

• Review clinical documentation to confirm all services rendered are documented completely and accurately prior to billing.
• Validate provider-selected CPT® and ICD-10-CM codes to ensure they are fully supported by medical record documentation.
• Make coding corrections in accordance with official coding guidelines, payer policies, and organizational standards.

• Ensure claims comply with National Correct Coding Initiative (NCCI/CCI) edits, modifier usage rules, and outpatient coding guidelines.
• Apply payer-specific coding and documentation requirements to support clean claim submission.
• Maintain compliance with CMS, state, and commercial payer regulations.
• Query providers to obtain missing, incomplete, or unclear documentation needed for accurate coding and billing.
• Communicate coding-related questions and feedback to providers in a clear, professional, and educational manner.
• Partner with Billing, A/R, and Revenue Cycle teams to resolve coding-related claim issues.

• Identify trends or recurring documentation and coding issues impacting reimbursement or compliance.
• Recommend provider education opportunities to improve documentation quality and coding accuracy.
• Assist with internal and external coding and documentation audits as requested.

• Perform manual coding of encounters based on medical records during system downtime, paper chart usage, or other business continuity needs.
• Support special coding projects, backlogs, or payer initiatives as assigned.
• Meet established productivity, accuracy, and turnaround time standards.
• Maintain detailed documentation of coding decisions, provider queries, and corrections.
• Stay current on coding updates, payer policy changes, and urgent care–specific guidelines.

• High school diploma or equivalent required;
  Associate degree or higher preferred.
• 2+ years of professional outpatient coding experience.
• Strong working knowledge of CPT®, ICD-10-CM, modifiers, CCI edits, and outpatient coding rules.

• Experience coding urgent care, emergency medicine, or high-volume ambulatory encounters.
• Familiarity with California payer requirements.
• Experience working within EHR and professional billing systems.
• Additional coding credentials (e.g., CPMA, COC) a plus.
• Strong attention to detail and analytical skills.
• Solid understanding of clinical documentation and coding guidelines.
• Effective written and verbal communication with providers and staff.
• Professional judgment and compliance-focused mindset.
• Ability to manage high-volume work independently.

Office or remote environment; flexibility for onsite work dictated by business needs.