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:

• Minimum of five (5) years of HIM and outpatient facility coding 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