Coding Specialist – Outpatient

• Report to the Coding Manager
• Review outpatient clinical documentation and medical records
• Extract data and assign appropriate ICD-10-CM, CPT, E/M, APC, charge master, injection, and infusion codes
• Ensure documentation supports assigned codes
• Use 3M 360 Finder to assign codes and resolve coding and claims edits
• Apply NCCI, CCI, NCD, OCE, and medical necessity requirements
• Confer with physicians for clarification and report documentation insufficiencies
• Monitor outpatient uncoded reports and ensure timely coding and billing
• Resolve rejected accounts, claims edit reports, and eClinical
  
  Works error reports
• Research and resolve coding, charge master, medical necessity, and billing issues
• Refer complex coding issues to the coding validator or supervisor
• Update patient financial accounts and rebill accounts as required
• Maintain coding knowledge, quality, productivity, and accuracy standards
• Perform related clerical duties

• High school diploma or equivalent
• Successful completion of a formal coding educational program
• Coding certification required from AHIMA or AAPC
• One to two years of experience in outpatient coding or billing
• Ability to read and understand outpatient clinic, ancillary, and endoscopy medical record documentation
• Ability to meet and maintain established quality and productivity standards
• Maintain an average accuracy rating of 95%
• Knowledge of outpatient ICD-10-CM Official Guidelines for Coding and Reporting
• Knowledge of AHA HCPCS Coding Clinics
• Knowledge of NCCI edits and medical necessity requirements
• Knowledge of Rhode Island Hospital Facility Coding Guidelines for adult patients
• Knowledge of 1995 Evaluation and Management Guidelines for patients under 18
• Ability to work under stressful conditions
• Ability to sit for long periods and lift at least 25 pounds; bend, stoop, stretch, and use step-stools
• No supervisory experience required; supervisory responsibility is none

Demonstrates expertise in outpatient coding, including proficiency in ICD-10-CM, CPT, and E/M coding, while ensuring compliance with medical necessity and documentation standards. Maintains high accuracy and productivity in coding practices, supported by relevant certifications and knowledge of coding guidelines.

• ICD-10-CM Coding
• CPT Coding
• Outpatient Coding Experience
• Coding Certification (AHIMA or AAPC)
• NCCI Edits Knowledge

• Data Extraction
• Medical Record Review
• Coding and Claims Resolution
• Documentation Support
• Quality Standards Maintenance
• Billing Issue Resolution
• Patient Financial Account Updates
• Coding Knowledge Maintenance
• Outpatient HCPCS Knowledge
• Evaluation and Management Guidelines Knowledge

• Attention to Detail
• Ability to Work Under Stress
• Communication with Physicians

• Coding Certification (AHIMA or AAPC)

• Outpatient Coding
• Medical Necessity Requirements
• Chargemaster
• NCCI
• CCI
• NCD
• OCE
• Rhode Island Hospital Facility Coding Guidelines
• Ancillary Medical Records
• Endoscopy Medical Records

• 3M 360 Finder
• EClinical Works