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About the Role
The Outpatient Coder accurately and timely codes hospital outpatient services, focusing on Emergency Department (ED) facility coding. This role involves reviewing clinical documentation to assign ICD-10-CM diagnosis codes, CPT/HCPCS procedure codes, modifiers, and facility E/M levels according to official guidelines and regulatory standards.
Responsibilities
- Reviews clinical documentation and assigns appropriate ICD-10-CM diagnosis codes.
- Assigns CPT/HCPCS procedure codes and modifiers.
- Assigns facility E/M levels in accordance with official coding guidelines, payer requirements, hospital policies, and regulatory standards.
- Interprets Emergency Department clinical documentation, including physician and nursing documentation.
- Works independently while meeting established productivity and quality expectations.
- Works coding edits, denials, and claim-related coding reviews.
Requirements
- Minimum 2 years of recent hospital Emergency Department facility coding experience preferred; demonstrated ED coding experience is required.
- Strong knowledge of ICD-10-CM, CPT, HCPCS, modifiers, and outpatient hospital coding guidelines.
- Experience assigning Emergency Department facility E/M levels.
- Knowledge of NCCI edits, medical necessity requirements, and outpatient reimbursement concepts.
- Proficiency with electronic health records and coding/encoder applications.
Skills
- ICD-10-CM
- CPT
- HCPCS
- Modifiers
- Outpatient hospital coding guidelines
- Emergency Department facility E/M levels
- NCCI edits
- Medical necessity requirements
- Outpatient reimbursement concepts
- Clinical documentation interpretation
- Analytical skills
- Organizational skills
- Communication skills
- Electronic health records
- Coding/encoder applications
- Infusion and Injection coding
- Same Day Surgery/Ambulatory Surgery coding
- Epic Hospital Billing (HB)
- Coding encoder applications
- Coding edits
- Denials
- Claim-related coding reviews
Experience Level
- Minimum 2 years of recent hospital Emergency Department facility coding experience preferred
Education Level
- Associates or Bachelors preferred
- CPC – Certified Professional Coder
- CCS – Certified Coding Specialist
- COC – Certified Outpatient Coder
- CCS-P – Certified Coding Specialist – Physician-based
- RHIT or RHIA