Senior Outpatient Coder: Appeals & Complex Cases Lead

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

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.