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 rendered by physicians and other qualified healthcare providers.

• Input coded/abstracted data into 3M 360 Finder and accurately assign APC codes.

• Examine and resolve coding edits, including those related to the National Correct Code Initiative (NCCI) and medical necessity requirements.

• Assign codes for injections and infusions administered to observation patients.

• Meet minimum productivity benchmarks while maintaining an average accuracy rating of 95%.

• Assign E/M, ICD-10-CM, CPT, and chargemaster codes for clinic visits.

• Verify provider-entered diagnosis, ICD, and CPT codes against medical record documentation.

• Report any documentation insufficiencies to the appropriate physicians.

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

• Monitor and resolve rejected accounts as well as eClinicalWorks error reports.

• Investigate coding discrepancies related to chargemaster, medical necessity, and billing issues.

• Refer complex coding matters to the coding validator or supervisor for further review.

• Review and address outpatient uncoded accounts and inappropriate charges.

• Update patient financial accounts in billing systems and adhere to rebilling protocols.

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

• Engage in compliance initiatives aimed at minimizing denials and audit findings.

• Perform related clerical tasks and maintain up-to-date coding knowledge.

⛳️ Requirements

• High school diploma or equivalent is mandatory.

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

• 1–3+ years of experience in professional (physician-based) coding.

• Experience in a specialty area is a plus.

• Comprehensive knowledge of ICD-10-CM, CPT, and HCPCS Level II coding guidelines.

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

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

• Excellent written and verbal communication abilities.

• Proficiency with 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.

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

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

• Ability to work independently while adhering to departmental policies and practices.

🏝️ Benefits

• Comprehensive health, dental, and vision insurance plans.

• Retirement savings plan with employer matching contributions.

• Generous paid time off and holiday schedules.

• Opportunities for professional development and continuing education.

• Employee wellness programs and resources.