Senior Outpatient Coder

Duties And Responsibilities

• Provides day-to-day leadership and operational support for assigned inpatient and/or outpatient coding workflows, work queues, facilities, and coding staff, consistent with delegated authority.
• Provides direct support to Coding Management, including process improvement, denials, special projects, coding edits, auditing, staff education, and other duties as assigned.
• Applies current official coding guidelines and authoritative guidance, including ICD-10-CM/PCS, CPT, HCPCS, UHDDS, Coding Clinic, CMS payment rules, and applicable payer requirements.
• Maintains at least 95% coding accuracy, or another threshold established by Coding Leadership, using the organization's approved audit methodology.
• Maintains coder productivity and quality at established intervals and provides timely, objective feedback, coaching, and education as directed by Coding Management.
• Ensures encounters processed by the coding team include an appropriate documented claim-hold reason before the account appears on the DNFB report.
• Collaborates with the CDI/Audit team to confirm second-level review is completed for applicable HAC, PSI, and Never Event cases in accordance with established workflows.
• Tracks and trends post-discharge coding queries, supports timely resolution, and provides feedback and education to ensure queries are non-leading, supported by the health record, and compliant with organizational policy and applicable guidance.
• Supports effective collaboration between Coding and CDI staff while maintaining role-appropriate accountability and compliant query practices.
• Supports Quality, Risk Management, Case Management, and other departments regarding HIM and coding matters within the scope of the role.
• Supports the development and implementation of coding and CDI policies and procedures.
• Maintains Discharged Not Final Billed goals established by Coding Leadership without compromising coding accuracy, documentation requirements, or compliance.
• Monitors and communicates changes in federal and state laws, regulations, accreditation standards, official coding guidance, CMS NCCI/OCE/MUE edits, and payer requirements that affect Coding and HIM operations.
• Performs or supports prospective, concurrent, and retrospective coding audits using an approved methodology; documents findings, identifies trends and potential overpayments or underpayments, and escalates compliance concerns through established channels.
• Protects the confidentiality, integrity, and security of protected health information and accesses only information necessary to perform assigned duties in accordance with HIPAA and organizational policy.
• Prompts reports suspected coding, billing, privacy, or compliance concerns through established channels and supports corrective action; does not alter the health record or direct unsupported coding.

Knowledge, Skills And Abilities

• Extensive knowledge of OPPS, IPPS, UHDDS, Coding Clinic, official coding guidelines, CMS NCCI/OCE edits, and applicable reimbursement methodologies.
• Microsoft Office (Word, One Note, Excel, Outlook, PowerPoint).
• Ability to interpret audit findings, coding-edit logic, and payer requirements and translate findings into staff education and process improvement.
• Excellent verbal and written communication skills.
• Ability to meet assigned deadlines.
• Extensive knowledge of Anatomy & Physiology, Medical Terminology, and Pathophysiology.

Work Experience, Education And Certifications

• EDUCATION: CCS Credential, RHIT or RHIA
• EXPERIENCE: 5-10 years progressive HIM coding management experience within an acute care hospital setting. Extensive experience with Revenue Cycle Operations including acute care coding
• CERTIFICATION/LICENSURE: RHIA or RHIT or CCS
• SOFTWARE/HARDWARE: 3M 360 experience required

Benefits

• Competitive salary and benefits package.
• Opportunities for professional development and advancement.
• A supportive work environment with a collaborative team.
• Comprehensive healthcare coverage.
• Retail savings plan.
• Paid time off and flexible scheduling options.
• Student loan repayment program.