Lead 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 the emergency department, outpatient clinic, same day surgery, or diagnostic testing (radiology and laboratory). Typically reports to the Coding Manager.

Qualifications

• High School Diploma or GED required; Associate’s degree in Health Information Management or any Healthcare Related Field preferred.
• Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or relevant Coding Certification(s) from American Health Information Management Association (AHIMA) or American Association of Professional Coders (AAPC) required.
• Six (6) years of hospital outpatient or ambulatory coding experience.
• Experience coding in a Level 1 trauma facility/academic teaching facility preferred.
• Strong knowledge of ICD-10-CM and/or CPT coding, human anatomy, physiology, medical terminology, and surgical terminology.
• Analytical skills necessary to interpret data in health records and assign appropriate codes.
• Critical thinking, good judgment, and decision-making skills.
• Knowledge of coding compliance policies, official coding guidelines, regulatory requirements, and internal policies and procedures.
• Proficient in navigating a Windows-based application environment.
• Effective oral and written communication skills.

Responsibilities

• Reviews medical record documentation to identify pertinent diagnoses/procedures requiring code assignment for outpatient records and accurately codes them using ICD-10 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.
• Stays current with coding guidelines and reimbursement reporting requirements; escalates concerns to the manager for resolution.
• Assigns ICD-10-CM, modifiers, and HCPCS codes to outpatient records.
• Maintains 92% to 95% accuracy in ICD-10-CM and/or HCPCS coding while meeting established productivity standards and minimizing abstracting errors.
• Mentors and trains newly hired coders and provides ongoing training to coding staff.
• Assists the Coding Manager with special coding assignments or tasks to resolve unbilled issues.
• Serves as a resource for coding-related questions, responding promptly to requests from coding staff.
• Adheres to the Standards of Ethical Coding as set forth by AHIMA and follows official coding guidelines.
• Ensures safe care for patients, staff, and visitors by following all Memorial Hermann policies, procedures, and standards within budgetary specifications.
• Promotes professional growth and development by meeting continuing education and skills competency requirements; supports departmental goals contributing to organizational success.
• Models Memorial Hermann’s service standards by providing safe, caring, personalized, and efficient experiences to patients and colleagues.
• Performs other duties as assigned.