Current CPC certification from AAPC, or CCS/CCS-P from AHIMA.
Must maintain certification through CEU requirements and active membership with the accrediting body.
Minimum 2 years of recent coding experience in Outpatient (OP) Hospital coding across multiple specialties.
Strong knowledge of coding across multiple specialties including E/M, General Surgery, Orthopedics, Cardiology, Gastroenterology, Neurology, Pulmonology, Urology, Obstetrics & Gynecology, Hospital Medicine, and Observation Services.
Thorough understanding of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS Level II.
Knowledge of NCCI edits, LCD/NCD guidelines, modifier assignment, medical necessity, APC and MS-DRG reimbursement.
Ability to accurately interpret physician documentation and assign diagnosis and procedure codes.
Experience with physician query processes and denial management.
Education in medical terminology, anatomy, and physiology.
Excellent verbal and written English communication skills.
Strong analytical, organizational, and problem-solving skills.
Ability to meet productivity and quality standards.
Proficiency with EMR/EHR systems, Microsoft Office, 3M Encoder, Codify, Cerner, Epic (preferred), and Citrix.
Ability to code using coding manuals when electronic tools are unavailable.
Key Responsibilities
Review and abstract information from electronic and handwritten medical records.
Assign accurate ICD-10-CM, ICD-10-PCS, CPT, and HCPCS codes to the highest level of specificity.
Perform coding for Outpatient Hospital encounters across multiple specialties.
Perform Inpatient coding in accordance with official coding guidelines and facility requirements.
Ensure compliance with CMS, AMA, AAPC, AHIMA, payer-specific, and client guidelines.
Review clinical documentation and issue compliant physician queries when clarification is needed.
Apply appropriate modifiers and ensure compliance with NCCI edits, LCD/NCD guidelines, and medical necessity requirements.
Assist with coding-related denial management, appeals, and coding discrepancy resolution.
Meet productivity and quality benchmarks.
Participate in coding audits, education, and quality improvement initiatives.
Stay current with coding guideline updates and payer requirements.
Collaborate with physicians, CDI specialists, billing teams, auditors, and operational leadership.
