Outpatient Department Facility Coder

Technical

Skills:

• Advanced knowledge of ICD-10-CM, CPT, HCPCS Level II, and modifier assignment for hospital outpatient services.
• Strong understanding of Official Coding Guidelines, CPT rules, Coding Clinic guidance, and CMS outpatient billing regulations.
• Proficiency in applying National Correct Coding Initiative (NCCI) edits and Outpatient Code Editor (OCE) edits.
• Knowledge of hospital outpatient reimbursement systems, including APC (Ambulatory Payment Classification) and OPPS (Outpatient Prospective Payment System).
• Ability to accurately interpret clinical documentation to support coding of diagnoses, procedures, and ancillary services.
• Strong understanding of medical terminology, anatomy, physiology, pharmacology, and disease processes relevant to outpatient care.
• Proficiency in assigning and validating HCPCS Level II codes for drugs, supplies, and outpatient services.
• Experience using electronic health records (EHRs), encoder systems, CAC tools, and revenue cycle platforms.
• Ability to identify and resolve coding edits, charge discrepancies, and claim issues impacting outpatient facility billing.

Required Experience:

• Minimum of 2–4 years of hospital outpatient coding experience, preferably in a facility (HB) environment.
• Active coding certification from AHIMA or AAPC, such as:
• • CCS (Certified Coding Specialist) – strongly preferred
  • COC (Certified Outpatient Coder) – strongly preferred for outpatient facility coding
  • CPC (Certified Professional Coder) – acceptable with strong outpatient facility experience
  • RHIT or RHIA
• Must maintain active credential status with required continuing education units (CEUs) per certifying body requirements.
• Demonstrated experience assigning ICD-10-CM, CPT, HCPCS Level II, and modifiers for outpatient hospital services.
• Experience working with APC/OPPS reimbursement methodology and outpatient hospital billing processes.
• Strong understanding of Official Coding Guidelines, Coding Clinic guidance, CPT rules, NCCI edits, and OCE edits.
• Experience reviewing clinical documentation to support accurate coding and charge capture in a hospital outpatient setting.
• Familiarity with electronic health records (EHRs), encoder software, CAC tools, and revenue cycle systems.
• Experience identifying coding errors, resolving claim edits, and supporting denial prevention efforts preferred.
• Prior experience in a hospital, health system, or large integrated delivery network (IDN) preferred.