Coder - Outpatient

About the role

Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for billing, internal and external reporting, research, and regulatory compliance. Demonstrate knowledge of reimbursement methodologies and apply these to assigned charts to optimize reimbursement and/or resolve regulatory edits. Resolve error reports associated with the billing process, identify and report error patterns, and, when necessary, assist in the design and implementation of workflow changes to reduce billing errors.

Responsibilities

• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines, and keeps abreast of coding changes and interpretation of codes.
• Performs detailed review of Inpatient record documentation to identify & assign diagnosis & procedure codes using ICD-10-CM and ICD-10-PCS.
• Meets established departmental productivity guidelines with 95% accuracy on a consistent basis.
• Utilizes Care Connect, UDS, and Clintegrity systems proficiently to obtain ICD10 codes and DRG assignment.
• Formulates compliant Physician Coding Queries when documentation is inadequate, ambiguous, or unclear for coding purposes.
• Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.
• Provides assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.

Requirements

Education: Associate of Science in Health Information Management (required).

Experience: At least 2 years of progressive coding experience in a hospital or multi-specialty physician practice setting preferred.

Physical requirements: Sedentary role primarily office-based, prolonged sitting (67–100% of workday), lifting

Qualifications

• One of the following certifications is required: Certified Coding Specialist (CCS), Certified Coding Specialist - Physician Based (CCS‑P), Certified Professional Coder (CPC), Certified Professional Coder Hospital Based (CPC‑H), Certified Medical Coder (CMC), Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), Certified Professional Coder Apprentice (CPC‑A), or a specialty coding certification.
• Candidates with an Associate degree from an accredited AHIMA program must sit for the RHIT exam within 1 year of hire.
• Full CPC certification must be obtained within 24 months if employee holds CPC‑A at time of hire (AAPC).
• For HOMECARE: Homecare Diagnosis Coding Specialist (HCS‑D) certification required within 16 months of hire.
• Grandfather clause: If hired on or before September 30, 2018, 2 years of relevant work experience and one of the listed coding certifications plus an Associate’s degree in Health Information Management are required.

Skills

• Proficient use of Care Connect, UDS, and Clintegrity systems to obtain ICD‑10 codes and DRG assignment.
• Ability to formulate compliant Physician Coding Queries when documentation is inadequate, ambiguous, or unclear.
• Skill in correcting failed claim errors, addressing accounts misclassified, and resolving other errors identified through auditing processes.
• Ability to provide assistance to physicians, clinical quality staff regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.
• Knowledge of reimbursement methodologies and application to optimize reimbursement and resolve regulatory edits.
• Ability to review clinical documentation and diagnostic results to extract data and apply appropriate ICD‑10‑CM and ICD‑10‑PCS codes for billing, reporting, research, and compliance.
• Ability to resolve error reports, identify and report error patterns, and assist in designing/implementing workflow changes to reduce billing errors.

Pay

$20.75 – $28.50 per hour (base pay range). Location: Rochester, NY 14617.

Schedule

Monday‑Friday, day shift (M‑F; Days). Full‑time.