Lead Coding Specialist - Outpatient Telecommute

Lifespan; Providence (RI); On-site; USD 60,000 - 75,000; Full time

Job summary

A leading health organization is seeking a Lead Outpatient Coder to oversee coding accuracy and productivity. The role involves reviewing medical records, ensuring compliance with coding guidelines, and mentoring new staff. Candidates must possess strong knowledge of coding standards and have at least three years of outpatient coding experience.

Qualifications

• Minimum of 3 years in outpatient coding.
• Maintain professional credentials through ongoing education.

Responsibilities

• Review outpatient medical records to accurately identify diagnoses and procedures.
• Collaborate with denial management teams to address coding-related denials.
• Conduct peer training and answer routine coding questions.

Skills

ICD-10 CM/PCS

CPT Coding

Critical Thinking

Education

Associate degree in health information technology

Coding certification from AAPC or AHIMA

Tools

EMR systems

Job description

Summary:
Under the general supervision of the Director of Ambulatory Coding Services, the lead outpatient coder reviews medical record documentation and all clinical documentation to extract data and assign appropriate codes in accordance with outpatient guidelines for professional and facility coding. Knowledge of ICD-10 CM/PCS and CPT Official Guidelines for Coding and Reporting for outpatient scenarios across complex disciplinary service lines at Brown University Health affiliates is required. The role involves determining appropriate code assignment for accurate classification and clinical reporting.

Responsibilities:

1. Review outpatient medical records across complex service lines to accurately identify diagnoses and procedures, reporting correct ICD-10 CM/PCS codes per official guidelines.
2. Ensure documentation supports code selection for diagnoses, procedures, complications, co-morbidities, and discharge disposition.
3. Recognize when physician queries are needed and recommend them to clarify incomplete or ambiguous documentation.
4. Maintain coding accuracy and productivity standards; serve as a resource on coding principles and guidelines.
5. Collaborate with denial management teams to address coding-related denials, including medical necessity and modifier issues.
6. Research payor policies related to outpatient coding and billing scenarios.
7. Conduct peer training and answer routine coding questions.
8. Apply critical thinking to identify and resolve coding problems promptly and develop solutions.
9. Serve as a preceptor and mentor to new staff, providing oversight and resources.
10. Recognize and interpret clinical documentation relevant to coding.
11. Prepare compliant physician queries with good written communication skills.
12. Participate actively in team meetings to promote excellence; adhere to the *Standards of Ethical Coding* by AHIMA.

Other Information:

• Education: Associate degree in health information technology or equivalent; coding certification from AAPC or AHIMA is required; maintain professional credentials through ongoing education.
• Experience: Minimum of 3 years in outpatient coding; working knowledge of EMR systems, ICD-10 CM/PCS, CPT, and HCPCS guidelines.
• Working Conditions: Prolonged sitting for record review; ability to work under stress to meet productivity and accuracy goals.
• Independent Action: Performs independently within departmental policies; escalates complex issues to supervisor when needed.
• Supervisory Responsibility: None

Brown University Health is an Equal Opportunity employer and a VEVRAA Federal Contractor.

Location: Brown University Health Corporate Services, USA:RI:Providence

Work Type: Full Time

Shift: Shift 1

Union: Non-Union