Coding Specialist – Outpatient

Role Overview

• Reviews and enters coded/abstracted outpatient encounter information into 3M™ 360 Finder, assigning accurate APCs and resolving all coding edits
• Applies National Correct Coding Initiative (NCCI) edits and medical necessity requirements
• Resolves accounts within the claims edit database and assigns injection and infusion codes for observation patients
• Meets or exceeds established productivity standards while maintaining a minimum coding accuracy rate of 95%
• Assigns E/M, ICD-10-CM, CPT, and chargemaster codes for outpatient clinic visits, ensuring documentation supports all code assignments
• Reviews provider-entered diagnosis and procedure codes for accuracy and documentation support
• Utilizes 3M™ tools to identify and resolve NCCI edits prior to final billing
• Identifies and reports documentation deficiencies to the responsible physician
• Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and the 1995 Evaluation and Management Guidelines for patients under 18
• Monitors and resolves rejected accounts from Claims Edit Reports and eClinicalWorks error reports within established timeframes
• Researches and resolves coding conflicts related to chargemaster issues, medical necessity, and other billing discrepancies
• Escalates complex coding issues to a coding validator or supervisor as appropriate
• Reviews outpatient uncoded reports and resolves aged or inappropriate charges
• Updates patient financial records in Patient Management and Patient Accounting systems and follows established rebilling procedures
• Maintains current knowledge and expertise relevant to outpatient coding practices and regulatory requirements

Requirements

• High school diploma or equivalent required
• Successful completion of a formal coding education program
• Ability to read and interpret outpatient medical record documentation involving clinic services, ancillary services, and endoscopy procedures
• Active coding certification required (AHIMA or AAPC)
• One to two years of outpatient coding or billing experience required
• Demonstrated ability to meet and maintain productivity and quality standards

Benefits

• Health insurance
• Professional development opportunities