Outpatient Coder

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

📋 Description

• Review ambulatory medical records for multi-specialty provider organizations to confirm that billed codes are accurately backed by clinical documentation.

• Translate medical record data into terminology that payers can comprehend to process physician charges.

• Ensure that coding adheres to all relevant coding guidelines.

• Assign the correct ICD-10 diagnosis codes and CPT/HCPCS procedure codes based on medical documentation, physician notes, and other relevant information.

• Complete coding tasks promptly to meet billing deadlines.

• Aid in resolving incomplete or missing documentation to facilitate faster billing.

• Communicate with healthcare providers to address coding queries and concerns.

• Conduct claim edit corrections and denial reviews related to coding inaccuracies.

• Identify coding or documentation trends that could jeopardize revenue and report them to management.

• Stay updated with coding and documentation guidelines, compliance policies, annual coding updates, payer policies, and industry developments.

• Undertake additional duties as assigned.

• Report directly to the Director of Revenue Integrity.

⛳️ Requirements

• High School Diploma or equivalent is required.

• CPC Certification is mandatory.

• 3-5 years of experience in CPT/HCPCS Outpatient coding, ideally in a multi-specialty facility.

• Familiarity with ICD-CM (current edition), CPT, HCPCS coding systems, and CCI edits.

• Understanding of third-party payer requirements, as well as federal and state guidelines and regulations regarding medical coding and billing.

• Knowledge of current ICD-10-CM and CPT/HCPCS Official Guidelines for Coding and Reporting.

• Familiarity with medical records content and management.

• Working knowledge of EMR systems through experience or education.

• Proficient in medical terminology.

• Awareness of laws and regulations concerning health information and patient confidentiality.

• Proficient in Microsoft Office applications, including Excel, Word, and PowerPoint.

• Ability to quickly learn new software and systems.

• Must be able to maintain a stationary position for 50-75% of the time.

• Familiarity with the MassHealth ACO program is preferred.

• Familiarity with Federally Qualified Health Centers is preferred.

• Experience with anti-racism initiatives and/or personal experience with racism is highly preferred.

• Prior experience with Epic is highly preferred.

🏝️ Benefits

• Competitive salary and benefits package.

• Opportunities for professional development and continuing education.

• Supportive work environment that values diversity and inclusion.