Coder Outpatient-Edits

Job Summary

The Outpatient Coder-Edits is responsible for daily review and resolution of outpatient (observation/surgical) coding-related alerts/edits by monitoring aging accounts and prioritizing, providing resolution, and identifying barriers preventing outpatient claims from being billed and reimbursed timely. This individual will be required to make independent decisions regarding accurate ICD-10-CMS & CPT/HCPCS code assignments which will play a key role in determining the reimbursement potential of CHS with adherence to compliant coding standards and corporate policies developed to ensure accurate billing.

Essential Functions

• Modify and complete moderate to high complexity outpatient coding edits/errors using ICD-10-CM, CPT and HCPCS (All outpatient types) or another designated coding classification system in accordance with coding rules and regulations; missing and/or incorrect modifiers, CCI edits, payor medical necessity denials, etc.
• Work in Bill Scrubber System (SSI) as required
• Enter Edit error root cause data in Fluency Time Capture under Activity for management to solve problems upstream and downstream
• Attends coding education as scheduled
• Other special projects or other duties assigned
• Maintains job specific productivity levels set forth by Community Health Systems while maintaining a 95% coding accuracy rate.
• May perform the work of lower level classification of the Coding Edit Resolution series especially

Qualifications

• H.S. Diploma or GED required
• Associate Degree in Health Information Management, Medical Coding, or a related field preferred or
• One (1) year coding certification in Health Information Management preferred
• 3 years of outpatient coding experience in an acute care hospital or healthcare system required
• Experience coding emergency department visits, outpatient procedures, interventional radiology, and/or ambulatory surgery preferred

Knowledge, Skills and Abilities

• Strong knowledge of ICD-10-CM, CPT, and HCPCS coding principles and outpatient reimbursement methodologies.
• Understanding of Local Coverage Determination (LCD), National Coverage Determination (NCD), and payer-specific coding guidelines.
• Experience with electronic health record (EHR) systems and coding software (e.g., 3M, Meditech, Epic, Cerner).
• Ability to analyze and resolve coding edits, rejections, and denials efficiently.
• Strong attention to detail and organizational skills.
• Excellent communication and problem-solving skills, with the ability to collaborate with CDI teams and billing departments.
• Knowledge of HIPAA regulations and patient privacy standards.

Licenses and Certifications

• Certified Coding Specialist (CCS) – AHIMA required or
• CCA - Certified Coding Associate required or
• Certified Outpatient Coder (COC) – AAPC required
• RHIA - Registered Health Information Administrator preferred or
• RHIT - Registered Health Information Technician preferred