Coding Specialist – Outpatient

This is a fully remote position, open to applicants in Rhode Island.

📋 Description

• Review, interpret, and assign ICD-10-CM, CPT, and HCPCS Level II codes for services provided by physicians and qualified healthcare professionals.

• Input coded and abstracted information into 3M 360 Finder, accurately assign APC codes, and review coding edits.

• Adhere to NCCI edits and medical necessity requirements.

• Resolve accounts within claims edit databases as well as rejected accounts on Claims Edit Reports and eClinicalWorks error reports.

• Assign injection and infusion codes for patients under observation.

• Allocate E/M, ICD-10-CM, CPT, or chargemaster codes to clinic visits based on documentation in medical records.

• Verify the accuracy of physician-entered diagnosis, ICD, and CPT codes, ensuring they are supported by documentation.

• Notify responsible physicians of any documentation insufficiencies.

• Adhere to the Rhode Island Hospital Facility Coding Guidelines and relevant Evaluation and Management Guidelines.

• Review uncoded outpatient reports and rectify old or inappropriate accounts.

• Update patient financial accounts within Patient Management and Patient Accounting systems.

• Follow procedures for rebilling accounts.

• Escalate complex coding issues to the coding validator or supervisor.

• Ensure compliance with CMS regulations, NCCI edits, MAC guidance, payer policies, as well as HIPAA, privacy, and security policies.

• Engage in compliance initiatives aimed at reducing coding-related denials and audit findings.

• Maintain a coding accuracy rate of at least 95% and meet established productivity benchmarks.

• Execute related clerical tasks while keeping up-to-date with relevant coding knowledge.

⛳️ Requirements

• A high school diploma or equivalent is required.

• One or more certifications are required: CPC (Certified Professional Coder) – AAPC; CCS or CCS-P (Certified Coding Specialist / Physician-based) – AHIMA.

• 1–3+ years of professional coding experience in a physician-based setting.

• Specialty experience is advantageous.

• Strong understanding of ICD-10-CM, CPT, and HCPCS Level II coding guidelines.

• Familiarity with medical terminology, anatomy, and healthcare documentation.

• Ability to accurately interpret complex medical documentation and apply coding guidelines.

• Excellent written and verbal communication skills.

• Proficiency in electronic health records (EHR); experience with Epic is preferred.

• Experience in E/M coding and/or surgical/procedural coding.

• Must maintain a secure and private workspace to protect PHI.

• Must utilize organization-approved secure systems (VPN, multi-factor authentication).

• Capability to meet deadlines while achieving productivity and accuracy standards.

• Ability to work independently within departmental policies and practices.

🏝️ Benefits

• Fully remote work arrangement.

• Secure systems and VPN/multi-factor authentication are provided and required for remote work.