Senior Outpatient Coder

About the role

This position is responsible for reviewing clinical documentation and assigning ICD-10-CM diagnosis, CPT/HCPCS procedure codes, and modifiers to ensure proper reimbursement for complex outpatient accounts. Requires extensive knowledge and understanding of ICD-10-CM and CPT/HCPCS coding guidelines, medical terminology, and disease processes. Works closely with clinicians and operations to ensure complete and accurate documentation, coding, and charges for the services provided. Adheres to the quality and productivity standards set by the department.

Responsibilities

• Evaluates health record documentation and accurate reimbursement by ensuring that ICD-10-CM diagnostic and CPT/HCPCS procedural codes, and modifiers accurately reflect and support the hospital-based outpatient encounter
• Identifies documentation clarification opportunities to ensure that documentation supports the coding and charges for the services provided.
• Initiates coding queries and provides feedback to clinicians
• Reviews Local Coverage Determination (LCD)/National Coverage Determination (NCD) policies for ICD-10-CM diagnoses that support medical necessity for services provided
• Works with the coding denials team for education and assists with denial prevention solutions
• Ensures outpatient accounts are coded accurately and in a timely manner
• Consistently maintains coding quality (95% accuracy) and productivity expectations
• Assists with the training of outpatient coders
• Performs related duties as required

Requirements

• Successful completion of a coding program, which included coursework in ICD-10-CM, CPT/HCPCS, medical terminology, anatomy and physiology and disease processes
• Two (2) years of hospital outpatient coding experience
• Passing score on the Essentia Health senior outpatient coding skills assessment

Qualifications

• Current certification with American Health Information Management Association (AHIMA) or AAPC and credentialed as Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Professional Coder (CPC), Certified Coding Specialist (CCS), and/or Certified Coding Specialist-Physician-Based (CCS-P)
• Epic experience
• 3M Encoder experience
• Computer Assisted Coding experience

Benefits

At Essentia Health, we’re committed to supporting your well-being, growth, and work-life balance. Our comprehensive benefits include medical, dental, vision, life, and disability