Senior Outpatient Coder

About the role

The Senior Outpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records, including all diagnoses and operative and diagnostic procedures in patient medical records, using the current International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedures Coding System (HCPCS), and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principal and secondary diagnoses and selected procedures.
• Identifies and analyzes patterns in possible coding errors or other trends and reports to the coding leadership team.
• Participates in mandated medical record review processes.
• Using current HCPCS, ICD-10-CM, and CPT coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
• Ensures that all factors necessary for assigning an accurate APC/APGs are present, and that all diagnoses are ranked properly.
• Makes appropriate contacts in order to acquire or clarify necessary information.
• Enters final diagnostic code numbers and narrative descriptions of diagnoses and procedures into an automated grouper system.
• Compiles and updates the appeal log detailing denials, hospital's reply and follow-up responses.
• Abstracts information from medical records to compile reports and statistical information.
• May train lower level coders and provide technical guidance and expertise.
• Queries appropriate provider as necessary regarding documentation of diagnosis and/or procedure.

Requirements

• Minimum of three years of experience where the primary function of the position must have been outpatient coding in an acute care setting.
• High School or equivalency diploma, required.
• Satisfactory completion of 30 credits toward an Associate’s degree or Bachelor’s degree in health information management may be substituted on a year-for-year basis for up to four years of the general coding experience; there is no substitution for the two years of specialized experience.
• Current certification as either a Certified Coding Specialist (CCS) or Certified Coding Specialist–Physician Based (CCS-P) through AHIMA, or as a Certified Professional Coder (CPC) through the American Academy of Professional Coders, required.
• Certification as Registered Health Information Administrator (RHIA) or as a Registered Health Information Technologist (RHIT) by the American Health Information Management Association.