Outpatient Coder I

Yale NewHaven Health; New Haven (CT); On-site; USD 60,000 - 78,000; Full time

Job summary

Yale NewHaven Health in New Haven, CT is seeking an Outpatient Coder 1 to review medical record documentation and assign accurate ICD-10-CM/PCS and CPT codes in a fast-paced outpatient setting.

Under the supervision of the OP Coding Supervisor, you will maintain high-quality coding and productivity, participate in education activities, and collaborate with clinicians to ensure compliant coding and claims processing.

Qualifications

• Bachelor's degree preferred with coursework in anatomy/physiology, medical terminology, pathophysiology, and disease processes.
• Requires minimum 2 years outpatient or professional coding experience in a complex service line; RHIT/RHIA or CCS/CCS-P may substitute.
• CCS/CCP-A or RHIT prerequisites and AHIMA/AAPC credential preferred.

Responsibilities

• Review medical records to determine ICD-10-CM codes per guidelines.
• Select CPT codes, modifiers, and ICD-10-PCS; resolve CCI edits as applicable.
• Maintain 95%+ coding quality across diagnostics and procedures.
• Meet departmental productivity and coding quality standards.
• Code at least one complex outpatient service line (e.g., Cardiology, IR, Oncology).
• Participate in ongoing education, journals, and coding education sessions.
• Use workflows and resources to meet billing goals with minimal supervision.
• Address returned cases for education and improvement.

Skills

Anatomy & physiology

Medical terminology

ICD-10-CM/PCS coding

CPT coding

Professional communication

Education

Bachelor's degree preferred (health informatics/related)

Tools

Epic

3M encoder

Job description

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

Under the general direction of the OP Coding Supervisor, the Outpatient Coder 1 is responsible for a comprehensive review of medical record documentation and performs a variety of coding related activities in one complex outpatient coding service line. Work may include, but is not limited to: coding cases, prioritizing assigned coding tasks , resolving claim edits, handling individual coding workload, working stop bills (if assigned), and sending queries, as needed, to clinical staff.

EEO/AA/Disability/Veteran

Responsibilities

• 1.Reviews medical record documentation to determine appropriate ICD-10-CM codes in accordance with official coding guidelines.
• 2.Reviews medical record documentation and accurately selects the appropriate CPT codes, modifiers, and ICD-10-PCS, when applicable, in accordance with official coding guidelines. This includes resolving CCI edits, as applicable.
• 3.Maintains a minimum of 95% overall coding quality score in diagnostic, procedural, and modifier code selection.
• 4.Maintains the productivity expectations as defined by the department for the coding service line.
• 5.Capable of coding a minimum of one complex OP service line, which would include: Cardiology, Interventional Radiology, Observation, Oncology, or Same Day Surgery at proficiency.
• 6.Participates and seeks out career development activities by reading journals, coding articles, researching procedures and/or disease processes to ensure appropriate code selection, regularly attends coding education sessions, and actively participates in learning circles.
• 7.Uses department resources regularly and follows workflows, with minimal assistance or intervention, to perform daily work to meet CFB (candidate for billing) goals.
• 8.Resolves cases returned coder for education and/or errors, and uses feed back to improve ongoing performance.
• 9.Handles coding DNBs and stop bills (if assigned), or other projects and/or coding initiatives as assigned.
• 10.Works with peers and/or leadership to create and maintain accurate up-to-date policies and procedures.
• 11.Exhibits enthusiasm for the profession, embraces educational opportunities and department support offered and remains engaged in the goals and vision of the department.

Qualifications

EDUCATION

Bachelors degree preferred. Requires course work, preferably college level, in anatomy and physiology, medical terminology, pathophysiology, and disease process.

EXPERIENCE

Requires a minimum of 2 years of outpatient or professional coding experience in a complex service line. Coding experience may be partly substituted for a college degree with an RHIT/RHIA credential or CCS/CCS-P coding credential. Prior experience in Epic and 3M encoder is preferred.

LICENSURE

CCS, CCS-P, or RHIT credential preferred. Must possess a valid coding credential through AAPC and/or AHIMA.CPC-A or CCA not accepted.

SPECIAL SKILLS

Comprehensive knowledge of anatomy/physiology, medical terminology, ICD-10-CM/PCS, and CPT coding with the ability to acclimate and apply knowledge in a fast-paced OP Coding department setting. Knowledge of professional E/M leveling preferred. Must possess excellent communications skills orally and in writing, strong critical thinking and reasoning skills, in addition to time management skills. Must be able to perform functions independently and under limited supervision.

YNHHS Requisition ID
161127