Coder Outpatient

The Outpatient Coder is responsible for accurately assigning ICD-10-CM, CPT, and HCPCS codes for outpatient services, including emergency department visits, outpatient surgeries, observation stays, interventional radiology, wound care, and ancillary procedures.

This role ensures compliance with coding guidelines, regulatory requirements, and corporate billing policies, while contributing to accurate reimbursement and data integrity.

The Outpatient Coder reviews medical records and applies appropriate codes within hospital coding systems.

Essential Functions

• Reviews and assigns appropriate ICD-10-CM, CPT, and HCPCS codes for outpatient records, ensuring compliance with coding and billing regulations.

• Codes spinal procedures, cardiac caths, interventional radiology, ortho procedures and EGD/Colonoscopies, along with OBS and wound care.

• Codes a variety of outpatient encounters, including observation stays, outpatient surgeries, interventional radiology, cardiac catheterization, emergency department visits, wound care, and ancillary services.

• Applies correct coding guidelines and payer-specific policies, ensuring adherence to LCD/NCD (Local Coverage Determination/National Coverage Determination) requirements.

• Resolves coding edits and denials, identifying and correcting discrepancies while maintaining compliance with corporate and regulatory standards.

• Maintains coding productivity and accuracy standards, achieving a 95% coding accuracy rate and meeting corporate benchmarks.

• Consults with the Manager or other subject matter experts to resolve complex coding issues and discrepancies.

• Collaborates with Clinical Documentation Integrity (CDI) specialists and billing teams, ensuring complete and accurate coding and documentation.

• Ensures adherence to HIPAA privacy and security standards, maintaining confidentiality of patient records.

• Utilizes hospital coding software and related tools to ensure accuracy and compliance with corporate policies.

• Performs other duties as assigned.

• Maintains regular and reliable attendance.

• Complies with all policies and standards.