Coding/Reimbursement Specialist-Certified

This position is eligible for remote work in Iowa, after 90 days of training is completed onsite.

POSITION OVERVIEW (non-exempt):

The Outpatient Coding/Reimbursement Specialist is responsible for the retrieval, assembly, deficiency analysis, and coding of outpatient medical records in accordance with health center guidelines. This role ensures timely chart processing and accurate outpatient reimbursement through charging, auditing, and compliance with applicable regulations. The specialist collaborates closely with providers and ancillary department staff to support accurate documentation and billing practices.

QUALIFICATIONS:

• CCS, CCA: Completion of an accredited certificate program for Medical/Insurance coding and successfully completing the AHIMA exam within 6 months of hiring. Must Maintain CCS/CCA credentials. 1-2 years of coding experience preferred, but not required

OR

• RHIT: Completion of an accredited program for Health Information Technology, obtaining an Associate of Applied Science Degree and successfully completing the AHIMA examination within 6 months of hire. Must maintain RHIT credentials. 1-2 years of coding experience preferred, but not required

ACCOUNTABILITY:

Reports to Health Information Manager

DIRECT REPORTS:

None

POSITION-SPECIFIC REQUIREMENTS:

Coding & Compliance

• Responsible for outpatient coding including ICD-10 CM & CPT
• Required to stay updated with coding guidelines and participate in continuing education
• Responsible for enforcing Medicare compliance guidelines as they apply to outpatient coding
• Responsible for assigning Evaluation & Management, CPT, and modifiers on ED and observation patients
• Operate Solventum encoder and Epic EHR efficiently
• Performs monthly therapy coding correlation for cycle billing

Reimbursement & Auditing

• Execute outpatient reimbursement functions including charging, auditing, and maintaining consistent interpretation of edits and regulations
• Follow established procedures for coding claim edits

Documentation & Systems

• Thorough knowledge and comprehension of established HIM office procedures, billing, coding routines and systems
• Follow established procedures for chart deficiencies
• Serve as backup to the Deficiency Clerk

General Duties

• Attends all required meetings and in-services
• Performs other related duties as requested or required

Skills and Competencies

• Strong analytical, oral, written, and communication skills
• Ability to communicate professionally and respectfully in person, remotely, and by phone.
• Excellent organizational and time management skills
• Ability to learn quickly from oral and written instructions
• High attention to detail and accuracy
• Proficient in Microsoft Outlook, Word, and Excel
• Solid understanding of medical terminology, anatomy, and physiology
• Proficiency in ICD-10-CM and CPT coding
• Knowledge of HIPAA and healthcare compliance regulations
• Ability to resolve coding discrepancies and collaborate with healthcare providers
• Ability to work independently and manage multiple tasks efficiently
• Strong teamwork skills with the ability to collaborate effectively across departments and contribute to a positive team environment

WORK ENVIRONMENT:

• Works in a well-illuminated, climate-controlled environment
• May come in contact with hazardous chemical or treatment modalities
• Possibility exists of exposure to communicable diseases
• Involvement in inpatient care may result in unavoidable work-related illness or injury
• Work environment is comfortable, with minimal exposure to physical hazards
• Moderate to loud noise environment when machines/equipment in use
• Involvement in checking in/moving of supplies may result in unavoidable work-related injury
• Must be constantly alert for patient/family emergency situations