OUTPATIENT CODER (CERT)

Job Summary

Codes and abstracts hospital outpatient medical records, including but not limited to, emergency department encounters, outpatient surgical services, observation services, rehabilitation services, infusion, and other hospital outpatient visits, for reimbursement, data reporting, research, and compliance with applicable coding guidelines and regulatory requirements. Assigns appropriate ICD-10-CM diagnosis codes, CPT procedure codes, and HCPCS codes based on provider documentation and applicable coding guidelines. Reviews medical records for completeness, accuracy, and appropriate code assignment; identifies documentation deficiencies and coding discrepancies; and coordinates follow-up or clarification when necessary. Applies established coding standards to support accurate billing, compliant reimbursement, data integrity, and revenue cycle performance.

• Job Specifications

EDUCATION AND EXPERIENCE

• High school diploma or equivalent required.
• Current coding certification from AAPC or AHIMA required. Acceptable credentials may include CPC, COC, CCS, CCA, RHIT, RHIA, or another organization-approved credential appropriate to the position.
• Minimum of 2-3 years of hospital outpatient coding experience required.
• Previous medical billing, claims processing, or revenue cycle experience is a plus.
• Experience with electronic health records, computerized coding and encoding software required.

ABILITIES, INTERESTS AND TEMPERAMENTS

• Coding Research and Education: Ability to research coding questions using authoritative resources, apply current guidance, and participate in continuing education to maintain coding competency.
• Hospital Operations and Revenue Cycle: General knowledge of hospital functions and the relationship among documentation, coding, billing, reimbursement, and timely account completion.
• Quality Assurance: Knowledge of coding accuracy standards, auditing practices, error identification, and corrective action to maintain coding quality and consistency.
• Computerized Coding Systems: Ability to use electronic health records, Solventum 3M encoder software, and other coding and reference tools to research coding questions and support accurate code assignment.
• Coding Edits and Modifiers: Knowledge of applicable coding edits, modifiers, code-specific reporting requirements, and other rules affecting accurate hospital outpatient code assignment.
• Medical Necessity and Reimbursement: Understanding of medical necessity requirements, applicable payer billing rules, and the relationship between coding accuracy, reimbursement, and compliant claims submission.
• Medical Terminology and Anatomy: Knowledge of medical terminology, anatomy, physiology, and common disease processes sufficient to accurately interpret clinical documentation for coding purposes.
• Documentation Review: Ability to review medical records for complete, accurate, and consistent documentation; identify discrepancies or missing information; and determine when clarification is needed.
• Official Coding Guidelines and Compliance: Knowledge of applicable official coding guidelines, regulatory requirements, payer policies, and organizational coding procedures.
• Hospital Outpatient Coding: Knowledge of coding requirements for emergency department encounters, outpatient surgery, observation services, and other hospital outpatient visits.
• CPT and HCPCS Coding: Knowledge of CPT and HCPCS coding systems and their application to hospital outpatient procedures, services, supplies, and other reportable services.
• ICD-10-CM Coding: Knowledge of ICD-10-CM coding conventions, guidelines, sequencing requirements, and appropriate diagnosis code assignment based on provider documentation.

JOB KNOWLEDGE

• Demonstrates accountability, sound judgment, dependability, and a commitment to accurate, timely, and compliant coding.
• Ability to work independently while recognizing when clarification, assistance, or escalation is necessary.
• Ability to maintain professional coding competency through continuing education and awareness of changes in coding guidelines, reimbursement requirements, and industry practices.
• Ability to accept feedback, participate in coding audits and educational activities, and apply identified opportunities for improvement.
• Ability to maintain confidentiality and safeguard protected health information in accordance with applicable laws, regulations, and organizational policies.
• Ability to understand the relationship between coding accuracy, compliant billing, reimbursement, data integrity, and overall revenue cycle performance.
• Ability to use computerized coding systems, electronic health records, and other software to retrieve information, analyze data, research coding questions, and complete assigned work.
• Ability to communicate professionally, diplomatically, and tactfully with physicians, hospital staff, and other departments to resolve coding and documentation issues.
• Ability to adapt to changes in coding guidelines, regulatory requirements, payer policies, software, workflows, and work volume.
• Ability to organize and prioritize work, manage competing demands, and complete assigned accounts within established timelines.
• Ability to identify documentation deficiencies and coordinate appropriate follow-up or clarification with physicians, other qualified healthcare providers, or designated personnel.
• Ability to research and resolve coding questions using authoritative references, payer guidance, and established organizational procedures.
• Exceptional attention to detail and the ability to maintain accuracy while working with complex medical records and varying service types.
• Strong analytical, critical-thinking, and problem-solving skills, including the ability to recognize inconsistencies, identify coding errors, and determine appropriate next steps.
• Ability to meet and maintain established coding accuracy standards, with a target of 95% or greater, and meet assigned productivity expectations.
• Ability to assign accurate and complete diagnosis and procedure codes based on medical record documentation and applicable coding guidelines.