Coder III Outpatient

Avera-Healt; Sioux Falls (SD); Remote; USD 35,000 - 52,000; Full time

Job summary

Avera Health in Sioux Falls seeks a Coder III to assign ICD-10-CM, CPT, and HCPCS codes for outpatient charts across multiple facilities. You will ensure accurate abstracting and handle more complex, high-dollar cases while mentoring junior coders.

The role requires AHIMA certifications within 180 days (CCS, RHIA, RHIT or CCS-P) and 4–6 years of coding experience, with a focus on audits, denials and medical necessity input.

Qualifications

• AHIMA-recognized coding certifications within 180 days required/preferred.
• 4-6 years of medical coding experience.
• Strong knowledge of ICD-10-CM, CPT and HCPCS.
• Experience with denials management and medical necessity input.

Responsibilities

• Review patient charts to code ICD-10-CM, CPT and HCPCS for outpatient services across facilities.
• Aim for accurate abstraction and coding for high-dollar cases.
• Lead denials management and provide input for appeals using coding guidelines.
• Act as SME on coding topics and educate/mentor coders I, III.

Skills

ICD-10-CM coding

CPT coding

HCPCS coding

Denials management

Mentorship/education

Education

CCS (AHIMA)

RHIA (AHIMA)

RHIT (AHIMA)

CCS-P (AHIMA)

Associate's Health Information Administration or Health Information Technology

Job description

Location:Avera Downtown Building-Sioux FallsWorker Type:RegularWork Shift:Day Shift (United States of America)Pay Range:The pay range for this position is listed below. Actual pay rate dependent upon experience.$25.50 - $38.00Position HighlightsYou Belong at AveraBe part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.A Brief OverviewResponsible for the timely and accurate assignment of diagnostic and procedural codes for most types of outpatient charts for multiple facilities within Avera Health, with a focus on the more complex and high-dollar cases. Accurate abstracting along with other reporting and editing function is also a major responsibility. The Coder III works independently to meet quality and production goals for the position. Varied amounts of time will be spent educating Coder I, III and III coders along with helping others with denials management.What you will doReview all aspects of a patient's clinical documentation in order to identify the appropriate sequence of ICD-10-CM, CPT, and HCPCS diagnosis and procedure codes for assigned patient charts across Avera's facilities. Understand ICD-10-CM, CPT and HCPC codes in depth, and be willing to update that knowledge through research or other educational opportunities.Focus on determining the appropriate APC/EAPC and/or appropriate medical coding for a variety of outpatient patient types including, but not limited to, surgeries, observation, injections/infusions, and/or oncology.Expected to have a mastery of the majority of all outpatient types in the outpatient service line and code those as needed.Serve as a subject matter expert for other health professionals within Avera on coding related topics.Queries physicians and clinical documentation staff to ensure a full capture of the clinical record.Assist staff with denials management, including the processing of edits, serving as a subject matter expert, or helping to provide input for medical necessity and other related appeals using appropriate coding guideline references.Lead communication between health information management, billing, and providers as needed.Maintains personal quality and production statistics in accordance to service line standards for a Coder I. Adheres to ethical standards regarding coding as set by Avera Health.Essential QualificationsThe individual must be able to work the hours specified. To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds. These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.Required Education, License/Certification, or Work Experience:Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) within 180 Days orRegistered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) within 180 Days orRegistered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days orCertified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 DaysPreferred Education, License/Certification, or Work Experience:Associate's Health Information Administration or Health Information Technology4-6 years of coding experienceExpectations and StandardsCommitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.Promote Avera’s values of compassion, hospitality, and stewardship.Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.Maintain confidentiality.Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.Benefits You Need & Then SomeAvera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.PTO available day 1 for eligible hires.Up to 5% employer matching contribution for retirementCareer development guided by hands-on training and mentorshipAvera is an Equal Opportunity Employer - Qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, Veteran Status, or other categories protected by law. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call 1-605-504-4444 or send an email to [e-mail].