Senior Outpatient Coder

Westchester Medical Center Health Network; Town of Mount Pleasant (NY); On-site; USD 90,000 - 130,000; Full time

Job summary

Westchester Medical Center Health Network is seeking a Senior Outpatient Coder to handle complex coding, appeals, and denials in an acute care setting. You will apply ICD-10-CM, CPT, and HCPCS coding systems, with leadership duties and guidance to junior staff.

Responsibilities include analyzing denials, coordinating with providers for documentation, and ensuring accurate APC/APG assignment. Strong proficiency and a relevant certification are required.

Qualifications

• Minimum of three years outpatient coding experience in an acute care setting.
• Proficiency in ICD-10-CM and CPT evidenced by a coding assessment before hire.
• High School diploma or equivalent; 30 credits toward an Associate’s degree may substitute for up to four years of general coding experience.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies AHIMA guidelines to support diagnoses and procedures.
• Identifies patterns in coding errors or trends and reports to coding leadership.
• Participates in mandated medical record review processes.
• Assigns and records accurate codes for diagnoses and procedures in the medical record.
• Ensures accurate APC/APG ranking and connects to necessary information.
• Enters final codes and narratives into an automated grouper system.
• Compiles and updates an appeal log detailing denials and responses.
• Abstracts information from records to compile reports and statistics.
• May train lower level coders and provide guidance.
• Queries providers for documentation improvement as needed.

Skills

ICD-10-CM coding

CPT coding

HCPCS coding

Education

Associate's degree in health information management

Job description

Job Summary

The Senior Outpatient Coder is responsible for addressing appeals to insurance companies and coding highly complex medical records, including all diagnoses and operative and diagnostic procedures in patient medical records, using the current International Classification of Diseases (ICD 10CM), Current Procedural Terminology (CPT) and Health Care Financing Administration Common Procedures Coding System (HCPCS), and entering coded information into an automated grouper system. Technical guidance and acting in a lead role is expected. Does related work as required.

Responsibilities

• Addresses appeals to insurance denials to facilitate expedient resolution and reimbursement.
• Interprets and applies American Hospital Association Official Coding guidelines to articulate and support principle and secondary diagnoses and selected procedures.
• Identifies and analyzes patterns in possible coding errors or other trends and reports to the coding leadership team.
• Participates in mandated medical record review processes.
• Using current HCPCS, ICD 10 CM, and CPT coding systems, assigns and records an accurate code to all diagnoses, procedures, and operations as documented by the attending physician in the indicated patient's medical record.
• Ensures that all factors necessary for assigning an accurate APC/APGs are present, and that all diagnoses are ranked properly.
• Makes appropriate contacts in order to acquire or clarify necessary information.
• Enters final diagnostic code numbers and narrative descriptions of diagnoses and procedures into an automated grouper system.
• Compiles and updates the appeal log detailing denials, hospital's reply and follow-up responses.
• Abstracts information from medical records to compile reports and statistical information.
• May train lower level coders and provide technical guidance and expertise.
• Query appropriate provider as necessary regarding documentation of diagnosis and/or procedure.

Qualifications/Requirements

Experience: Minimum of three years of experience where the primary function of the position must have been outpatient coding in acute care setting.

Demonstrate proficiency in ICD 10 CM and CPT by passing coding assessment administered before hire.

Education: High School or equivalency diploma, required. Satisfactory completion of 30 credits* toward an Associate’s degree or Bachelor’s degree in health information management may be substituted on a year for year basis for up to four years of the general coding experience. There is no substitution for the two years of specialized experience.

Licenses / Certifications: Current certification as either a Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician Based (CCS-P) through AHIMA, or as a Certified Professional Coder (CPC) through the American Academy of Professional Coders, required. Certification as Registered Health Information Administrator (RHIA) or as a Registered Health Information Technologist (RHIT) by the American Health Information Management Association