Lead Certified Outpatient Hospital/Facility Coding Specialist

Memorial Hermann Health System; Nashville (TN); On-site; USD 65,000 - 90,000; Full time

Job summary

Memorial Hermann Health System seeks a skilled coder to perform primary diagnosis and procedural coding for ambulatory and hospital outpatient settings, including ED, clinics, and diagnostics. You will ensure accurate ICD-10-CM and HCPCS coding for reimbursement and compliance.

Required credentials include RHIT/RHIA or AHIMA/AAPC certification and 6 years of outpatient coding experience. Strong communication and analytical abilities are essential.

Qualifications

• High School Diploma or GED required; Associates degree preferred.
• RHIT, RHIA, or AHIMA/AAPC coding certification required.
• Six years of hospital outpatient or ambulatory coding experience.

Responsibilities

• Review records to assign ICD-10-CM and HCPCS codes for outpatient care.
• Ensure documentation supports diagnoses and procedures for reimbursement.
• Query physicians when documentation is unclear or incomplete.
• Maintain 92%–95% ICD-10-CM/HHCPCS coding accuracy and productivity targets.
• Mentor new coders and provide ongoing coding training.
• Adhere to AHIMA standards and regulatory guidelines.

Skills

Attention to detail

Effective communication

Analytical thinking

Critical thinking

Time management

Education

High School Diploma or GED

Associates degree in Health Information Management or related field

Tools

Windows

Job description

At Memorial Hermann, we pursue a common goal of delivering high quality, efficient care while creating exceptional experiences for every member of our community. When we say every member of our community, that includes our employees. We know that when our employees feel cared for, heard and valued, they are inspired to create moments that exceed expectations, while prioritizing safety, compassion, personalization and efficiency. If you want to advance your career and contribute to our vision of creating healthier communities, now and for generations to come, we want you to be a part of our team.

Job Summary

Responsible for primary diagnosis and procedural coding for designated ambulatory and hospital outpatient setting. Responsible for proficiently assigning proper and accurate medical codes for diagnosis, procedures, and services performed in an outpatient setting, such as but not limited to the following designated areas: emergency department, outpatient clinic, same day surgery, or diagnostic testing (radiology and laboratory). Typically reports to the Coding Manager.

Minimum Qualifications

Education: High School Diploma or GED required; Associates degree in Health Information Management or any Healthcare Related Field preferred

Licenses/Certifications: Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or relevant Coding Certification(s) from American Health Information Management Association (AHIMA) or American Association of Professional Coders (AAPC) required.

Experience / Knowledge / Skills

• Six (6) years of hospital outpatient or ambulatory coding experience.
• Experience coding in a level 1 trauma facility/academic teaching facility preferred.
• Effective oral and written communication skills.
• Strong knowledge of ICD-10-CM and/or CPT coding.
• Analytical skills necessary to interpret data contained in the health records and to assign appropriate codes.
• Strong knowledge of human anatomy, physiology, medical terminology and surgical terminology.
• Critical thinking, good judgment and decision-making skills.
• Knowledge of coding compliance policies, official coding guidelines, regulatory requirements and internal policies and procedures affecting the coding process.
• Proficient in navigating a Windows-based application environment.

Principal Accountabilities

• Reviews medical record documentation to identify pertinent diagnosis/procedures that require code assignment for outpatient records and accurately code the diagnoses and procedures using ICD-10 coding conventions for the purpose of reimbursement, research, and compliance with federal regulations.
• Reviews the medical record to assure specificity of diagnoses, procedures, and appropriate reimbursement for hospital and professional charges.
• Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Keeps abreast of coding guidelines and reimbursement reporting guidelines and brings identified concerns to manager for resolution.
• Effectively assigns ICD-10-CM, modifiers and HCPCS codes to outpatient records.
• Responsible in maintaining 92% to 95% ICD-10-CM and/or HCPCS coding and consistently meet established productivity standards while keeping abstracting errors to a minimum.
• Mentors and trains newly hired Coders and provides ongoing training of Coding staff.
• Assists the Coding Manager with special coding assignments or coding tasks to resolve unbilled issues.
• Serves as a resource for all coding related questions, responding in a timely manner to requests and questions from Coding staff.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines.
• Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor and resource to less experienced staff.
• Demonstrates commitment to caring for every member of our community by creating compassionate and personalized experiences. Models Memorial Hermann’s service standards by providing safe, caring, personalized and efficient experiences to patients and colleagues.
• Other duties as assigned.