Outpatient Coder

Title: Outpatient Coder

Reports to: Director of Revenue Integrity

Classification: Individual Contributor

Location: Remote

Job description revision number and date : V 2.0; 5.11.2026

Organization Summary:

Community Care Cooperative (C3) is a 501(c)(3) non-profit multi-service organization governed by Federally Qualified Health Centers (FQHCs). Our mission is to leverage the collective strengths of FQHCs to improve the health and wellness of the people we serve. We fulfill two primary business functions for the FQHCs we work with. First, we are an FQHC-led accountable care organization (ACO); second, we are a Management Services Organization (MSO) for FQHCs.

As an ACO, we negotiate value-based payor contracts on behalf of our FQHCs, hold and operate those contracts (including fulfilling many compliance, financial management, and population health management functions), and maximize the return to FQHCs of any incentive dollars earned. We are proud to be the market leader in the MassHealth ACO Program. We are the largest Medicaid ACO in Massachusetts, and we operate a variety of business offerings nationwide.

As an MSO, we (along with our subsidiary companies, which are also FQHC-led non-profits) provide several financial, operational, and technological services to groups of FQHCs. These services include Epic EHR licensing and implementation; pharmacy operations consulting as well as the building and direct operation of on-site retail pharmacies; billing and credentialing; employer-sponsored insurance; and others.

We are a fast-growing, dynamic organization developing new partnerships and programs to improve the health of members and communities, and to strengthen our health center partners.

Job Summary:

The Certified Outpatient Coder will be a part of an emerging coding team under the billing and credentialing service that performs coding review for FQHCs that are part of the billing service. The Outpatient Coder will report to Director of Revenue Integrity and is responsible for reviewing ambulatory medical records for multi-specialty provider organizations to ensure billed codes are accurately supported by the clinical documentation. The coder will also be responsible for interpreting medical record data into language that the payers can interpret in order to process physician charges, and ensuring that coding is compliant with all coding guidelines.

Responsibilities:

• Assigns appropriate diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) to patient encounters based on medical documentation, physician notes, and other information

• Ensures all coding is completed in a timely manner to meet billing deadlines

• Assists in resolving incomplete and/or missing documentation in order to expedite billing

• Communicates with healthcare providers to clarify coding questions and concerns

• Performs Claim edit corrections and Denial reviews related to coding errors

• Identify coding or documentation trends that may pose a risk to revenue stream and report such trends to management team

• Stay abreast of coding and documentation guidelines, compliance policies, annual coding updates, payer policies and industry changes

• All other duties as assigned

Required Skills:

• Knowledge of ICD-CM (current edition) CPT, HCPCS coding systems as well as CCI edits

• Knowledge of third-party payer requirements, federal and state guidelines and regulations on medical coding and billing

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

• Knowledge of medical records content and management

• Working knowledge of the EMR either through experience or education

• Medical terminology

• Knowledge of laws and regulations about health information and patient confidentiality

• Proficient in Microsoft office applications such as Excel, Word and PowerPoint

• Demonstrating flexibility with respect to changing end-user business needs

• Good interpersonal and communications skills and demonstrates professionalism when working with team members, management and other staff members.

• The ability and willingness to take ownership of work activities and ensure that they are completed in an accurate, efficient, and timely manner

• The ability and willingness to learn new software and systems

• Ability to determine a problem’s cause and developing a course of action to resolve the problem and to prevent its recurrence

• The ability to persevere in difficult situations and overcome obstacles

• Must be able to remain in a stationary position 50-75% of the time

Desired Other Skills:

• Familiarity with the MassHealth ACO program

• Familiarity with Federally Qualified Health Centers

• Experience with anti-racism activities, and/or lived experience with racism is highly preferred

Qualifications:

• High School Diploma or equivalent required

• CPC Certification required

• 3-5 years CPT/HCPC Outpatient coding experience, preferably in a multi-specialty facility

• Prior Epic experience highly preferred