Senior Outpatient Coder
Position Details:
Full-Time Remote
Reports to Coding Operations Manager
You must reside in one of these states to be eligible for this position:
Arkansas California Kentucky
Massachusetts Nevada New Mexico
Oregon Utah Tennessee
Texas Wyoming
Job Summary:
- The Senior Coder supports assigned inpatient and/or outpatient coding operations through day-to-day workflow leadership and may provide oversight of coding quality, coding edits, auditing, and staff education.
- Assigned functions may include inpatient, observation, emergency department, ambulatory surgery, ancillary, clinic, and other hospital-based coding services.
- The position supports Revenue Cycle Operations with special projects, including denial review, appeals, discharge-not-final-billed management, regulatory and payer edit review, and process improvement efforts designed to meet organizational goals while promoting accurate, complete, and compliant coding and billing.
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.
- Monitors 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.
- Ensures accounts are not final billed until required documentation is available and assigned codes are supported by the health record, consistent with organizational policy and applicable billing requirements.
- Coordinate workflow improvements with HIM Operations Team(s).
- Assists in developing, implementing, and monitoring coding policies and procedures that support accurate coding, appropriate reimbursement, and compliance with federal and state laws, regulations, official coding guidelines, and payer requirements.
- Supports effective collaboration between Coding and CDI staff while maintaining role-appropriate accountability and compliant query practices.
- Adheres to the AHIMA Standards of Ethical Coding, the organizational code of conduct, and applicable compliance policies, and promotes compliant coding practices within assigned workflows.
- Maintains Discharged Not Final Billed goals established by Coding Leadership without compromising coding accuracy, documentation requirements, or compliance.
- Ensures coding policies related to HIM, Revenue Cycle, and Compliance are implemented and monitored within assigned areas.
- Implements HIM related projects at the direction of Coding Leadership.
- Supports Quality, Risk Management, Case Management, and other departments regarding HIM and coding matters within the scope of the role.
- Assists HIM, Coding, and CDI Leadership with the development and implementation of coding and CDI policies and procedures.
- 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.
- May develop and deliver staff education, coaching, and reference materials based on audit findings, coding-edit trends, denial trends, regulatory changes, and identified knowledge gaps; documents education as required.
- May research, review, resolve, and trend coding edits, including NCCI, OCE, MUE, encoder, claim-scrubber, and payer-specific edits; validates that any modifier or code change is supported by the health record and applicable guidance.
- May perform or support 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.
- Promptly 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.
- Ability to maintain objectivity, confidentiality, and accurate audit documentation and to communicate compliance concerns through established channels.
- 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
Travel Requirements:
- Expected travel is up to 10% at the request of leadership.
Benefits:
- Competitive salary and benefits package.
- Opportunities for professional development and advancement.
- Supportive work environment with a collaborative team.
- Comprehensive healthcare coverage.
- Retirement savings plan.
- Paid time off and flexible scheduling options.
- Student loan repayment program.
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