Medical Coder (Outpatient)

Role Overview

The Medical Coder (OP) is responsible for accurately assigning ICD-10-CM and CPT diagnosis and procedure codes for outpatient services. This role ensures coded data is complete, compliant, and supports appropriate reimbursement, quality reporting, and regulatory requirements.

Assignment Details:

• 100% REMOTE
• Position Type: 1099 Independent Consultant
• At least 5 years of OP facility and/or profee coding experience, required
• AHIMA or AAPC certified
• Part-time hours, approximately 20
• EMR experience preferred: Athena
• Start Date: Within 1 – 2 weeks
• Per case pay rates
• Must complete and pass an OP coding assessment test and successfully code 10-15 charts.

Key Responsibilities

Medical Coding

• Review complete outpatient medical records to accurately determine the principal and secondary diagnoses, procedures, and complications
• Assign accurate ICD-10-CM and CPT codes for diagnoses and procedures
• Accurately sequences diagnoses and procedures
• Ensure documentation supports DRG/APC assignment and severity of illness (SOI) and risk of mortality (ROM)
• Strive to obtain the optimal DRG assignments on each medical record coded with assistance of computer system
• Query providers for clarification when documentation is incomplete, inconsistent, or unclear
  • Appropriately hold accounts when more information is required for accurate code/DRG assignment
  • Contact appropriate staff, leadership or medical staff as needed
• Meet established productivity and accuracy benchmarks
  • Demonstrate a consistent level of productivity and performance
  • Achieve productivity standards for each assignment
  • Maintain a monthly coding accuracy and DRG accuracy rate of 95% or above
• Collaborate with CDI, compliance, and billing teams to resolve coding issues
• Participate in internal audits, external audits, and education initiatives
• Works as a team member to meet department and client specific goals
• Complete all assignments in conscientious and reliable manner

Compliance

• Ensure compliance with the following: 
  • AHA official coding guidelines, AMA CPT guidelines, UHDDS definitions, coding clinics
  • Standards of Ethical Coding set forth by AHIMA, AAPC and CMS and other regulatory standards
  • Client-specific coding guidelines, policies and procedures except when in conflict with official coding guidelines
• Maintain confidentiality and comply with HIPAA regulations

Education & Training

• Regularly reviews coding literature to stay current on new or revised coding guidelines
• Maintains appropriate certifications from AHIMA/AAPC
• Expresses interest in and pursues continuing education

Perform additional duties as assigned and assist with other tasks as requested.

Required Skills & Qualifications

Experience:

Education:

• Associates degree preferred in Health Information Management, Healthcare Administration, other healthcare related fields, or Business Administration or Management, Bachelor’s degree preferred
• Candidates with significant relevant experience and demonstrated expertise may be considered in place of formal educational requirements.

Credentials/Certifications:

• CCS or CPC required
• Additional credentials preferred (RHIA, RHIT, CCS-P, CPMA, COC, CIC, CRC)

Skills & Knowledge:

• Advanced knowledge of medical terminology and pharmacology, ICD-10-CM, CPT, HCPCS, APCs, HCCs, HACs
• Advanced knowledge of documentation standards and improvement methodologies
• Knowledge and use of grouper and encoder systems, 3M/Nuance Clintegrity preferred
• Knowledge and use of EMR’s, Epic/Powerchart preferred
• Strong organizational, analytical and problem-solving abilities and techniques
• Client relationship and management skills
• Strong proficiency in Microsoft Office
• Ability to work independently in a remote environment