Outpatient Coder - SS Revenue Cycle - Toledo Market

Mercy Health; United States; Remote; USD 55,000 - 75,000; Full time

Job summary

An established industry player is seeking a skilled outpatient coder to join their remote team. This role involves reviewing medical records and accurately coding outpatient visits using advanced coding software. The ideal candidate will have a strong background in outpatient surgery coding and a commitment to maintaining compliance with federal regulations. With a focus on quality and productivity, you will play a key role in ensuring accurate claims processing. Join a forward-thinking organization that values your expertise and offers a comprehensive benefits package, including medical, dental, and educational assistance.

Benefits

Medical Insurance

Dental Insurance

Vision Plans

Prescription Coverage

FSA

Life Insurance

Retirement Contributions

Paid Time Off

Educational Assistance

Qualifications

• Must have outpatient surgery coding experience and knowledge of ICD-10.
• Completion of coding curriculum and at least one year of coding experience.

Responsibilities

• Review medical records and assign appropriate coding using 3M software.
• Monitor and process accounts for timely outpatient claims.

Skills

Outpatient Surgery Coding Experience

ICD-10-CM

ICD-10-PCS

CPT IV

Medical Terminology

Anatomy

Physiology

Coding Software Proficiency

Education

Vocational/Technical Degree in HIM

2-year/Associate's Degree in HIM

Tools

3M Software

CAC Software

Job description

Thank you for considering a career at Mercy Health!

Scheduled Weekly Hours: 40

Work Shift: Days (United States of America). This position is a work-from-home role.

Must have Outpatient Surgery Coding Experience

Advanced outpatient coding position that reviews medical record documentation and accurately assigns ICD-10-CM, ICD-10-PCS, and CPT IV codes based on the specific record type. The role involves abstracting specific data elements for each case in compliance with federal regulations, coding all types of outpatient visits including ancillary, urgent care, emergency department, observation, same-day surgery, and interventional procedures. Follows the Official Guidelines for Coding and Reporting, AHIMA Coding Ethics, AHA Coding Clinics, CMS directives, and Bulletins, utilizing coding applications in accordance with established workflow. Maintains compliance with Mercy Policies and Procedures, ensuring quality and productivity standards are met.

ESSENTIAL FUNCTIONS

1. Review medical record documentation and accurately assign appropriate ICD-10-CM, ICD-10-PCS, CPT IV, and HCPCS codes using 3M software for all outpatient work types. Support the reason for the visit and medical necessity documented by the provider. Apply charges such as E&M levels and infusions as applicable.
2. Abstract required data per facility specifications.
3. Perform medical necessity checks for Medicare and other payers as required.
4. Monitor and process accounts such as Discharged Not Final Billed, failed claims, stop bills, and epremis to ensure timely, compliant outpatient claims processing.
5. Maintain productivity and quality standards as per established KPIs and guidelines.
6. Stay updated on CMS requirements, including NCD and LCD guidelines, to ensure accurate modifier assignment and clean claims submission.
7. Utilize coding tools and reference materials accurately, report software inaccuracies, and report unethical or fraudulent activities per policy.
8. Follow all policies and procedures, including PTO requirements.
9. Attend meetings and educational sessions as required, completing annual learning programs.
10. Participate in training and mentoring responsibilities where applicable.

Minimum Education: Vocational/Technical Degree in HIM or Coding Certification. Preferred: 2-year/Associate's Degree in HIM or Coding.

Licensure/Certifications: Must have active, non-expired certifications such as RHIA, RHIT, CCA, COC, CCS, or CPC. If holding RHIA, RHIT, or CCA without COC or CCS, must acquire these within 1 year.

Minimum Qualifications: Completion of coding curriculum and at least one year of coding experience. Knowledge of medical terminology, anatomy, physiology, ICD-10 training, and proficiency with coding software tools. Ability to work independently and under deadlines, maintain accuracy, and communicate effectively.

Preferred: Experience in an acute care setting and familiarity with CAC software.

MercyHealth is an equal opportunity employer. Our benefits include medical, dental, vision plans, prescription coverage, FSA, life insurance, retirement contributions, paid time off, educational assistance, and more. Benefits vary by employment status.

Department: SS Revenue Cycle - Legacy MH Acute

We comply with all applicable laws and policies, ensuring non-discrimination based on race, color, national origin, religion, sex, sexual orientation, gender identity, age, genetic information, veteran status, or disability. For more information or accommodations, contact [e-mail].