Certified Outpatient Hospital/Facility Coding Specialist

About the Role

Responsible for primary diagnosis and procedural coding for designated ambulatory and hospital outpatient settings. Proficiently assigns proper and accurate medical codes for diagnosis, procedures, and services performed in outpatient settings such as emergency departments, outpatient clinics, same-day surgeries, or diagnostic testing (radiology and laboratory). Typically reports to the Coding Manager.

Qualifications

Education: High School Diploma or GED required; Associate’s degree in Health Information Management or any healthcare-related field preferred.

Certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or relevant coding certification(s) from the American Health Information Management Association (AHIMA) or American Association of Professional Coders (AAPC) required.

Experience / Knowledge / Skills:

• Surgery/Observation: Three (3) years of hospital or ambulatory coding experience required.
• Emergency Department: Two (2) years of hospital or ambulatory coding experience required.
• Interventional Radiology: Two (2) years of hospital or ambulatory coding experience required.
• Ancillary/Recurring: One (1) year of hospital or ambulatory coding experience preferred.
• Experience coding in a Level 1 trauma facility/academic teaching facility preferred.
• Effective oral and written communication skills.
• Strong knowledge of ICD-10-CM and/or CPT.
• Analytical skills necessary to interpret data in health records and assign appropriate codes.
• Proficient knowledge of human anatomy, physiology, medical terminology, and surgical terminology.
• Critical thinking, good judgment, and decision-making skills.
• Knowledge of coding compliance policies, official coding guidelines, regulatory requirements, and internal policies and procedures affecting the coding process.
• Proficient in navigating a Windows-based application environment.

Responsibilities

• Reviews medical record documentation to identify pertinent diagnoses/procedures requiring code assignment for outpatient records and accurately codes diagnoses and procedures using ICD-10-CM coding conventions for reimbursement, research, and compliance with federal regulations.
• Reviews medical records to ensure specificity of diagnoses, procedures, and appropriate reimbursement for hospital and professional charges.
• Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes.
• Stays current with coding guidelines and reimbursement reporting requirements; escalates concerns to the manager for resolution.
• Effectively assigns ICD-10-CM, modifiers, and HCPCS codes to outpatient records.
• Maintains 95% or greater accuracy in ICD-10-CM and/or HCPCS coding while consistently meeting established productivity standards and minimizing abstracting errors.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Ensures safe care to patients, staff, and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications, including time management, supply management, productivity, and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals contributing to organizational success; serves as a preceptor, mentor, and resource to less experienced staff.
• Demonstrates commitment to caring for every member of the community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.
• Performs other duties as assigned.