OP Coder
Job Description
The OP Coding Specialist III is an advanced-level Outpatient Coding Specialist responsible for reviewing, analyzing, and accurately coding outpatient medical records for. This position applies current ICD-10-CM, CPT, HCPCS, and modifier coding guidelines, Official Coding Guidelines, and regulatory requirements to ensure accurate, compliant, and complete outpatient coding.
As a senior-level outpatient medical coder and coding subject matter expert, the OP Coding Specialist III receives coding assignments based on advanced education, training, certification, and professional experience. This position may also mentor and proctor Coding Specialist I and II employees and provide expertise across designated outpatient coding service lines.
Earnings
$39-42 hourly
Location - Remote
Job Type
Duties
- Perform retrospective coding of outpatient medical records using ICD-10-CM, CPT, HCPCS, and applicable modifiers.
- Apply current Official Coding Guidelines, coding conventions, organizational policies, departmental requirements, and regulatory standards to ensure accurate and compliant outpatient coding.
- Accurately identify and assign: Reason for Visit, First-Listed Diagnosis, Appropriate Secondary Diagnoses, Outpatient Procedures, CPT Codes, HCPCS Codes, Applicable Modifiers
- Ensure coded services appropriately support medical necessity and resolve or prevent applicable: LCD edits, NCD edits, CCI edits
- Validate charge-master-driven CPT code assignments and route discrepancies or issues through the appropriate channels.
- Accurately abstract required data elements, including discharge disposition, procedure dates, physician information, applicable occurrence codes, and other designated clinical and administrative data.
- Review clinical documentation to identify missing, incomplete, conflicting, or unclear information.
- Identify when a physician query is appropriate to obtain additional documentation or clarification.
- Route documentation and coding issues appropriately in accordance with established UTSW/HIM Coding procedures.
- Complete coding review and final coding when physician query responses or additional documentation become available.
- Maintain established UTSW/HIM Coding quality standards and ensure coding accuracy and compliance.
- Meet established coding productivity standards while maintaining a high level of accuracy.
- Mentor, train, and proctor Coding Specialist I and II employees on designated outpatient coding service lines as requested.
- Maintain expert knowledge of outpatient coding guidelines, CPT, HCPCS, ICD-10-CM, modifiers, medical necessity, NCCI/CCI edits, LCDs, NCDs, and coding compliance practices.
- Perform other duties and responsibilities as assigned.
Requirements
- 3–5 years of acute hospital-based coding experience required.
- Equivalent combinations of education and experience may be considered.
- Remote coding experience preferred and required for PRN coders.
- Advanced computer skills and knowledge required.
- Associate or Bachelor's degree in Health Information Management (HIM) or a closely related field preferred
- Experience with outpatient medical coding, clinical documentation review, and healthcare coding compliance preferred.
- One of the following professional credentials is required: RHIA, RHIT, CCS, COC, CPC, CPC-H
Preferred Technical Skills
- Knowledge of 3M 360
- Experience with Epic Electronic Medical Record (EMR/EHR)
- Advanced knowledge of ICD-10-CM
- Strong knowledge of CPT and HCPCS coding
- Knowledge of coding modifiers
- Experience resolving CCI/NCCI edits
- Knowledge of LCD and NCD medical necessity requirements
- Clinical documentation review and physician query experience
- Strong data abstraction and electronic medical record skills