Coder Outpatient

We are seeking an experienced Facility Outpatient Coding Specialist to support a large academic university health system and Level I Trauma Center. This role is focused exclusively on outpatient coding edits and claim review activities, ensuring accurate code assignment, modifier usage, National Correct Coding Initiative (NCCI/CCI) compliance, and medical necessity validation across multiple outpatient specialties.

The ideal candidate will have strong outpatient edit experience, a thorough understanding of payer guidelines, and proficiency with both Cerner and 3M coding applications.

Key Responsibilities

• Review and resolve outpatient coding edits for facility-based services.
• Analyze and correct NCCI/CCI edits to ensure coding compliance and claim accuracy.
• Review and apply appropriate modifiers based on documentation and payer requirements.
• Validate and address medical necessity edits in accordance with CMS and payer guidelines.
• Collaborate with coding, compliance, revenue cycle, and clinical teams to resolve coding discrepancies.
• Maintain coding quality standards while meeting productivity and turnaround time expectations.
• Stay current with coding regulations, payer policies, and industry best practices.
• Support accurate reimbursement through compliant coding and edit resolution processes.

Required Qualifications

• Minimum 2 years of facility outpatient coding experience.
• Demonstrated experience working outpatient coding edits, including:
  • NCCI/CCI edits
  • Modifier review and application
  • Medical necessity review
• Experience supporting multiple outpatient specialties.
• Strong understanding of CMS regulations, payer policies, and outpatient reimbursement methodologies.
• Experience using Cerner and 3M coding systems (required).
• Excellent analytical, problem-solving, and communication skills.
• Ability to work independently in a remote environment while maintaining quality and productivity standards.

Preferred Qualifications

• Certified coding credential such as:
  • CPC
  • CCS
  • CCS-P
  • RHIT
  • RHIA
• Experience supporting academic medical centers or Level I Trauma Centers.
• Prior experience with outpatient facility claim editing and revenue integrity workflows.

Training & Schedule

• Initial Training: First week requires availability Monday through Friday, 8:00 AM to 4:00 PM MST.
• Post-Training Schedule: Flexible scheduling may be available based on business needs, performance, and management approval.

Work Environment

This is a remote position supporting a university-based health system and Level I Trauma Center. The role requires attention to detail, strong coding knowledge, and the ability to effectively manage outpatient coding edit workflows in a fast-paced healthcare environment.

Qualifications

Required Qualifications

• Minimum 2 years of facility outpatient coding experience.
• Demonstrated experience working outpatient coding edits, including:
  • NCCI/CCI edits
  • Modifier review and application
  • Medical necessity review
• Experience supporting multiple outpatient specialties.
• Strong understanding of CMS regulations, payer policies, and outpatient reimbursement methodologies.
• Experience using Cerner and 3M coding systems (required).
• Excellent analytical, problem-solving, and communication skills.
• Ability to work independently in a remote environment while maintaining quality and productivity standards.