Outpatient Coding Specialist

Outpatient Coding Specialist

The Outpatient Coding Specialist plays an essential role in ensuring the accuracy, consistency, and compliance of medical coding and billing processes. Working remotely within a healthcare environment, you will review outpatient medical records, assign appropriate ICD-10-CM diagnosis codes, and extract relevant information to support claims processing and reporting. You will help maintain coding accuracy while ensuring compliance with federal regulations and established industry standards. The role involves collaborating with clinical and administrative teams to resolve documentation and billing discrepancies. You will also contribute to revenue cycle efficiency by ensuring timely coding and supporting medical necessity reviews. This is an excellent opportunity for a detail-oriented coding professional looking to develop their expertise in healthcare revenue cycle management.

Accountabilities

• Review outpatient and ancillary medical records to identify relevant diagnoses, verify provider documentation, and ensure accurate code assignment and sequencing.
• Assign appropriate ICD-10-CM diagnosis codes using coding software and encoder tools, following official coding and reporting guidelines, Coding Clinic recommendations, and applicable hospital-specific standards.
• Verify medical necessity requirements by reviewing encoder edits and relevant CMS policies, investigating potential denials through examination of physician documentation and electronic medical records.
• Review charges in the Cerner billing system to ensure accuracy and timely submission, communicating discrepancies or issues to the appropriate department managers.
• Monitor pre-bill reports and actively contribute to revenue cycle activities by completing coding assignments within established deadlines.
• Participate in training and educational activities to maintain coding expertise, stay informed about regulatory updates, and fulfill continuing education requirements.
• Uphold professional ethical coding standards established by the American Health Information Management Association (AHIMA) and applicable industry regulations.

Requirements

• Required coding certification: CPC, CPC-A, CCS, CCS-P, or CCA. Candidates holding a CPC or CPC-A credential must obtain the AHIMA CCA credential within two years of hire.
• Candidates interested in progressing to advanced coding positions, such as Inpatient Coding Specialist or Outpatient Coding II Specialist, must obtain a CCS or CCS-P certification within two years of moving into those roles.
• Previous coding experience in a medical center or healthcare setting is preferred.
• Working knowledge of healthcare regulatory requirements, Ambulatory Payment Classifications (APCs), coding modifiers, and accounts receivable processes is an advantage.
• Familiarity with ICD-10-CM coding guidelines, medical necessity requirements, reimbursement procedures, and electronic health record systems.
• Basic computer proficiency, including fundamental PC maintenance and troubleshooting skills.
• Strong attention to detail and analytical abilities, with the capacity to review medical documentation and identify coding discrepancies.
• Excellent organizational, communication, and problem-solving skills, with the ability to collaborate effectively across clinical and administrative teams.
• Commitment to professional development, ethical coding practices, accuracy, and regulatory compliance.

Benefits

• Salary: $17.95$26.93 per hour.
• Schedule: Full-time position, 40 hours per week, Monday through Friday, daytime schedule.
• Health coverage: Health and dental insurance for eligible employees.
• Retirement plans: Illinois Municipal Retirement Fund (IMRF), 457 plan, and 401A retirement plan.
• Financial protection: Life insurance, short-term and long-term disability coverage, and optional insurance plans.
• Flexible spending: Medical and dependent care flexible spending accounts.
• Paid time off: Paid leave benefits.
• Career development: Tuition reimbursement, student loan forgiveness opportunities, and continuing education support.
• Employee support: Employee Assistance Program.
• Additional perks and discounts: Discounts on gift shop purchases, childcare services, dietary services, and pharmacy and vision center services.