Outpatient Senior Coder - ED - Remote

Tenet Healthcare; United States; Remote; USD 40,000 - 80,000; Full time

Job summary

An established industry player is seeking a detail-oriented coding specialist to join their team. In this crucial role, you will be responsible for accurately assigning diagnostic and procedural codes to patient charts, ensuring compliance with coding rules and regulations. Your expertise in ICD-10-CM, CPT, and HCPCS coding will be essential as you navigate complex medical records. This position offers opportunities for professional development and requires a commitment to maintaining high coding accuracy. Join a dynamic environment where your contributions will directly impact patient care and coding quality.

Qualifications

• Proficient in outpatient coding guidelines and CPT/HCPCS coding.
• Experience in medical record coding in an acute care setting preferred.

Responsibilities

• Assign diagnostic and procedural codes to patient charts of moderate to high complexity.
• Review medical records for accuracy and adherence to coding standards.

Skills

ICD-10-CM Coding

CPT Coding

HCPCS Coding

Outpatient Diagnosis Coding Guidelines

Documentation Review

Education

High School Diploma

Basic Coding Course

One Year of Medical Record Coding Experience

Job description

JOB SUMMARY

Responsible for assigning diagnostic and procedural codes (outpatient surgery, observation, infusion services, and interventional procedure records) to patient charts of moderate to high complexity using ICD-10-CM, CPT, and HCPCS or other designated coding systems, in accordance with coding rules and regulations. Abides by the Standards of Ethical Coding set by AHIMA. Abstracts required clinical information from medical records.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Include the following; others may be assigned.

1. Coding: Reviews medical records to accurately assign documented diagnoses and procedures, adhering to AHIMA's Standards of Ethical Coding.
2. Abstracting: Reviews medical records to determine accurate abstracting elements, including discharge disposition.
3. Coding Quality: Achieves accuracy and consistency in selecting principal and secondary diagnoses (including MCC & CC) and procedures, with a goal of ≥95% accuracy per monitoring period.
4. Coding Labor Productivity: Meets or exceeds Conifer’s coding productivity guidelines.
5. Professional Development: Keeps current with AHA Coding Guidelines, CMS directives, and attends mandatory and quarterly coding seminars and updates.
6. Issue Resolution: Communicates and resolves coding issues such as documentation gaps or physician queries for follow-up.

KNOWLEDGE, SKILLS, ABILITIES

To perform satisfactorily, the individual must:

• Be proficient in outpatient diagnosis coding guidelines and CPT/HCPCS coding, including E&M and PCS codes.
• Have working knowledge of OPPS.
• Compare documentation, code assignment, and charges for accuracy; escalate concerns appropriately.
• Establish effective working relationships, concentrate with accuracy, and proficiently use office and support software.

OTHER REQUIREMENTS

• Must obtain and provide proof of required vaccinations and screenings, including COVID-19, if applicable.

EDUCATION / EXPERIENCE

• Preferred: One year of medical record coding in an acute care setting.
• High school diploma or equivalent required.
• Completion of basic coding course covering medical terminology, anatomy, and physiology, or equivalent experience.

CERTIFICATES, LICENSES, REGISTRATIONS

• AHIMA or AAPC approved credential required.

PHYSICAL DEMANDS

• Sitting, using a computer, answering phones, ability to travel, including hospital environments.

WORK ENVIRONMENT

• Office and hospital settings.

OTHER

• Willingness to travel up to 10% nationally.