OP Medical Coder
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Key skills for this role
Key Skills for This Role
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Claims Processing and Coding
- Verify ICD-10-CM and CPT or HCPCS codes on outpatient UCF or discharge summaries before insurance submission.
- Review physician documentation for discrepancies between diagnoses, documentation, and selected procedure codes.
- Upload outpatient electronic claims to DHPO and other required claims portals.
- Identify excluded diagnoses, non-billable procedures, commonly used codes, and coding variations.
- Assign appropriate CPT or HCPCS codes for newly added services and procedures.
- Prepare daily audit and documentation reports covering claim discrepancies and coding concerns.
Resubmission and Coordination
- Review discharge notes for completeness and obtain missing information from physicians.
- Provide coding clarification to consultants, clinicians, insurance medical teams, billing supervisors, and accountants.
- Discuss specialty-specific claim rejections with clinicians and advise on rejection prevention.
- Coordinate submission, resubmission, follow-up, reconciliation, and final sign-off of claims.
- Provide coding training materials and support to cashiers, claims processors, and nurses.
- Enter codes in the software application and comply with company policies and procedures.
Education and Certification
- Bachelor's degree from an accredited college or university.
- A bachelor's degree in nursing, pharmacy, physiotherapy, or a related discipline is preferred.
- AAPC or AHIMA certification is required.
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