Senior Medical Coder - Outpatient Clinic Coding and Denial Management

Senior Medical Coder – OP Clinic Coding Denial Management

Hospital Outpatient Department (HOPD) Facility Coding

Remote | Night Shift (5:30 PM – 1:30 AM IST)

About Us

Opti Claim Business Solutions provides medical coding and revenue cycle services to U.S. healthcare providers, with a dedicated team supporting hospital outpatient clinic (HOPD) coding and denial resolution. We're hiring experienced coders who bring accuracy to this hospital-based facility coding environment.

Role Overview

This role sits within our Hospital Outpatient Department (HOPD) coding team, supporting hospital-owned outpatient clinics. It is a facility coding role — not a professional fee (pro-fee) coding role. You'll code outpatient clinic encounters under the hospital's facility structure, assign facility E/M levels using HCPCS G0463, and resolve coding denials on those claims in Claim Source, working from root-cause identification through correction and resubmission.

Key Responsibilities

Coding

- Assign ICD-10-CM, CPT, HCPCS Level II, and modifiers for outpatient clinic (HOPD) encounters.
- Level facility visits using HCPCS G0463, based on documentation.
- Code outpatient surgeries/procedures, radiology & imaging, lab & pathology, and infusion services performed in the hospital-based clinic setting.
- Assign revenue codes and support APC grouping for facility claims.
- Apply NCCI/CCI edits and modifiers correctly within the facility coding structure.

Coding Denial Management

- Review coding denials in Claim Source and identify the root cause.
- Cross-check claim details in Cerner, 3M, and STAR to validate facility documentation.
- Correct coding and resubmit denied claims; escalate billing-scope issues to the billing team.
- Support hold-case review in 3M, resolving or escalating pending documentation issues before billing.
- Track denial trends and flag fixes to prevent repeat denials.
- Run coding quality checks/audits to keep facility coding accuracy high.

Must-Have Expertise

- Facility E/M coding using HCPCS G0463, within a hospital outpatient clinic (HOPD) setting.
- APC logic, revenue codes, and OCE edit resolution.
- Coding denial investigation, correction, and resubmission via Claim Source.
- Outpatient facility coding: surgeries & procedures, radiology/imaging (CPT 70010–79999), lab & pathology (CPT 80047–89398), infusion services (CPT 96360–96379), and clinic specialties such as Cardiology, PT/OT, and Wound Care.
- Common modifiers:

-24,
-25,
-27,
-57,
-59,
-73,
-74, G0.
- Hands-on experience with 3M, Cerner, Claim Source, and STAR.
- Comfortable working in a hospital-based (HOPD) facility coding environment.

Qualifications

- CPC, CCS, or equivalent coding certification.
- 3+ years of outpatient facility (HOPD) coding experience.
- 2+ years resolving coding denials in an outpatient facility setting.
- Working knowledge of 3M, Cerner, Claim Source, and STAR.
- Prior experience coding for a hospital-owned outpatient clinic preferred, over independent physician office (pro-fee) coding.

Apply directly on the job post or send your resume to