Certified Professional Coder, Outpatient Billing
This role is responsible for ensuring accurate, compliant, and complete coding of professional outpatient encounters in a high-volume urgent care environment. This role reviews provider documentation, validates and corrects CPT® and ICD-10-CM code selection, queries providers for missing or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding requirements prior to billing. This role also plays a key role in supporting provider coding and documentation audits and manual coding activities required during system downtime or special operational needs.
Key Responsibilities
- Documentation Review & Coding Validation
- Review clinical documentation to confirm all services rendered are documented completely and accurately prior to billing.
- Validate provider-selected CPT® and ICD-10-CM codes to ensure they are fully supported by medical record documentation.
- Make coding corrections in accordance with official coding guidelines, payer policies, and organizational standards.
- Coding Accuracy & Compliance
- Ensure claims comply with National Correct Coding Initiative (NCCI/CCI) edits, modifier usage rules, and outpatient coding guidelines.
- Apply payer-specific coding and documentation requirements to support clean claim submission.
- Maintain compliance with CMS, state, and commercial payer regulations.
- Provider Queries & Collaboration
- Query providers to obtain missing, incomplete, or unclear documentation needed for accurate coding and billing.
- Communicate coding-related questions and feedback to providers in a clear, professional, and educational manner.
- Partner with Billing, A/R, and Revenue Cycle teams to resolve coding-related claim issues.
- Provider Education & Improvement
- Identify trends or recurring documentation and coding issues impacting reimbursement or compliance.
- Recommend provider education opportunities to improve documentation quality and coding accuracy.
- Assist with internal and external coding and documentation audits as requested.
- Manual Coding & Special Projects
- Perform manual coding of encounters based on medical records during system downtime, paper chart usage, or other business continuity needs.
- Support special coding projects, backlogs, or payer initiatives as assigned.
- Productivity, Documentation & Continuous Improvement
- Meet established productivity, accuracy, and turnaround time standards.
- Maintain detailed documentation of coding decisions, provider queries, and corrections.
- Stay current on coding updates, payer policy changes, and urgent care–specific guidelines.
Required Qualifications
High school diploma or equivalent required; Associate degree or higher preferred.
Active Certified Professional Coder (CPC®) credential required.
2+ years of professional outpatient coding experience.
Strong working knowledge of CPT®, ICD-10-CM, modifiers, CCI edits, and outpatient coding rules.
Preferred Qualifications
Experience coding urgent care, emergency medicine, or high-volume ambulatory encounters.
Familiarity with California payer requirements.
Experience working within EHR and professional billing systems.
Additional coding credentials (e.g., CPMA, COC) a plus.
Key Competencies
Strong attention to detail and analytical skills
Solid understanding of clinical documentation and coding guidelines
Effective written and verbal communication with providers and staff
Professional judgment and compliance-focused mindset
Ability to manage high-volume work independently
Working Conditions
Office or remote environment; flexibility for onsite work dictated by business needs