Outpatient Professional Coder

Job Description

GENERAL SUMMARY:

As an Outpatient Professional Coder, you'll play a vital role in our healthcare organization by translating complex medical documentation into accurate diagnostic and procedural codes that drive both reimbursement and quality patient care. Your expertise in coding principles and procedures directly impacts our organization's financial health, data integrity, and ability to support medical research and clinical decision-making. This position ensures compliance with coding guidelines and regulations while optimizing reimbursement and maintaining the highest standards of accuracy and professionalism.

PRINCIPAL DUTIES AND RESPONSIBILITIES:

Clinical Documentation & Analysis

• Conduct thorough reviews of patient medical records to identify all diagnostic and operative procedures requiring coding

• Analyze provider documentation with precision to assign or verify appropriate Evaluation & Management (E&M) CPT codes

• Collaborate with medical staff to clarify documentation and ensure complete, accurate information capture

Coding Expertise & Accuracy

• Apply advanced technical coding principles and APC reimbursement expertise to assign appropriate ICD-9-CM diagnoses and CPT procedures

• Assign diagnostic and procedural codes in strict accordance with established coding guidelines and best practices, utilizing encoder software

• Review and assign appropriate charges and facility E/M levels with attention to detail and regulatory compliance

Quality Assurance & Compliance

• Verify completeness of medical records within the electronic medical record system and report discrepancies to supervisors

• Request and verify supporting documentation to ensure full compliance with coding standards and third-party reimbursement policies

• Review system-generated error reports to identify, correct, and complete missing data elements

• Review and resolve coding errors, edits, rejections, and disputes with accuracy and professionalism

Professional Standards & Compliance

• Maintain current working knowledge of applicable Federal, State, and local laws, regulations, and organizational policies

• Uphold the Organizational Integrity Program and Standards of Conduct, demonstrating honest, ethical, and professional behavior in all interactions

• Adhere to Remote Coding Program Policy requirements if participating in remote coding opportunities

• Perform additional related duties as assigned

Qualifications:
Qualifications

** EDUCATION/EXPERIENCE REQUIRED:**

• High School Diploma or G.E.D. equivalent required.
• Some college or additional coursework in Accounting, Business, Healthcare Administration or Medical Record Sciences preferred.
• Must have a thorough knowledge of anatomy, physiology, pathophysiology, disease processes, medical terminology, pharmacology, and coding systems. Six (6) months prior coding experience preferred, but not required.

CERTIFICATIONS/LICENSURES REQUIRED:

• Certification as a Registered Health Information Technician (RHIT), RHIT Certification eligibility, or CPC, CPC-A, CCS, CCP or CCA certification required.
• Must meet or exceed core customer service responsibilities, standards and behaviors as outlined in the HFHS’ Customer Service Policy
• Must practice the customer skills as provided through on-going training and in-services.

Additional Information

** PHYSICAL DEMANDS/WORKING CONDITIONS :**

Normal office environment with minimal exposure to noise, dust, or extreme temperatures.