Coder III Outpatient

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

Benefits offered by this job

PTO day 1

401(k) match up to 5%

Mentorship program

Job summary

Avera is seeking a Coder III to accurately assign ICD-10-CM, CPT, and HCPCS codes for outpatient charts across multiple facilities. The role emphasizes high-quality abstracting, complex case focus, and mentoring newer coders.

You will work with physicians and staff to maximize documentation capture, support denials management, and collaborate with HIM and billing teams to move health care forward in a patient-centered way.

Qualifications

• Certified coding professionals with AHIMA credentials or eligible within 180 days.
• Experience with outpatient coding and medical record abstracts is preferred.

Responsibilities

• Review clinical documentation to assign ICD-10-CM, CPT, and HCPCS codes for outpatient charts across facilities.
• Determine APC/EAPC and medical coding for outpatient types including surgeries, observations, injections/infusions, and oncology.
• Code majority of outpatient service types as needed.
• Serve as SME for coding topics to other health professionals within Avera.
• Query physicians and staff to ensure full capture of the clinical record.
• Assist staff with denials management and input for medical necessity appeals using coding guidelines.
• Lead communication between HIM, billing, and providers as needed.
• Maintain personal quality and production statistics in line with service line standards for a coder I.

Skills

ICD-10-CM coding

CPT coding

HCPCS coding

Denials management

Coding guidelines

Education

CCS (AHIMA)

RHIA (AHIMA)

RHIT (AHIMA)

CCS-P (AHIMA)

Associate's degree in Health Information Management/Technology

Job description

Remote

Sioux Falls, SD

Full time

R-260031350

Location:

Avera Downtown Building-Sioux Falls

Worker Type:

Regular

Work Shift:

Day Shift (United States of America)

Pay Range:

$25.50 - $38.00

Position Highlights

You Belong at Avera

Be 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 Overview

Responsible 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 do

• Review 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 Qualifications

The 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 or
• Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) within 180 Days or
• Registered Health Information Tech (RHIT) - American Health Information Management Association (AHIMA) within 180 Days or
• Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Association (AHIMA) within 180 Days

Preferred Education, License/Certification, or Work Experience:

• Associate's Health Information Administration or Health Information Technology
• 4-6 years of coding experience

Expectations and Standards

• Commitment 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 Some

Avera 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 retirement
• Career development guided by hands‑on training and mentorship

Avera 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].

At Avera , the way you are treated as an employee translates into the compassionate care you deliver to patients and team members. Because we consider health care a ministry, you can live out your faith, uphold the dignity and respect of all persons while not compromising high-quality services. Join us in making a positive impact on moving health forward.

At Avera , we are committed to protecting your online privacy. For more information, please visit https://www.avera.org/legal-notices/online-privacy-policy/

The policy of Avera to provide opportunities for all qualified employees or applicants without regard to disability and to provide reasonable accommodations for all employees or applicants who may be disabled. Avera is committed to ensuring compliance in accordance with the Americans with Disability Act. For assistance, please contact HR Now at 605-504-4444.

Additional Notices:

For TTY, dial 711

Avera is an Equal Opportunity/Affirmative Action Employer: Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity.