Outpatient Coding Specialist
Role Overview
The Outpatient Coding Specialist is responsible for reviewing, analyzing, and accurately coding outpatient medical records in accordance with established coding guidelines, regulatory requirements, and institutional policies.
The incumbent abstracts relevant clinical information and assigns appropriate diagnosis and procedure codes to ensure accurate documentation, coding compliance, and appropriate reimbursement for outpatient services.
The position requires knowledge of medical terminology, clinical documentation, outpatient coding methodologies, and applicable healthcare reimbursement guidelines.
The Outpatient Coding Specialist works collaboratively with physicians, clinical departments, and Health Information Management staff to resolve documentation deficiencies, maintain coding accuracy, and support the integrity of the institution's health information and revenue cycle processes.
Key Skills for This Role
Full Job Posting
Required Qualifications
- High School Diploma or equivalent.
- Minimum of one (1) year of direct professional medical coding experience in a hospital or outpatient healthcare setting.
- Current professional certification in at least one of the following:
- Registered Health Information Administrator (RHIA) – American Health Information Management Association (AHIMA).
- Registered Health Information Technician (RHIT) – American Health Information Management Association (AHIMA).
- Certified Coding Specialist (CCS) – American Health Information Management Association (AHIMA).
- Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC).
- Demonstrated knowledge of ICD-10-CM, CPT, and applicable HCPCS Level II coding systems and official outpatient coding guidelines.
- Knowledge of medical terminology, anatomy and physiology, and clinical documentation relevant to outpatient coding.
- Ability to review and interpret medical records, abstract clinical information, and independently assign appropriate diagnosis and procedure codes.
- Understanding of coding compliance standards, documentation requirements, and patient confidentiality regulations.
- Strong analytical skills, attention to detail, organizational skills, and the ability to work independently while maintaining accuracy and meeting established deadlines.
- Effective written and verbal communication skills, including the ability to communicate with physicians and other healthcare professionals regarding clinical documentation and coding matters.
Preferred Qualifications
- Bachelor's Degree in Health Information Management, Health Information Technology, Health Sciences, or a closely related field.
- Three (3) to five (5) years of direct medical coding experience in an acute care hospital or hospital-based outpatient setting.
- Experience coding outpatient hospital services, including ambulatory surgery, emergency department, outpatient procedures, or other hospital-based outpatient encounters.
- Experience utilizing electronic health record systems, computerized coding applications, and coding reference tools.
- Familiarity with outpatient reimbursement methodologies, coding edits, payer requirements, and coding compliance audits.
- Experience working collaboratively with physicians and clinical departments to resolve documentation deficiencies and improve coding accuracy.
Responsibilities
- The outpatient coder role is essential to the timely and accurate assignment of diagnosis and procedure codes for outpatient services. Accurate coding ensures compliance with federal and state regulations, supports appropriate reimbursement, maintains data integrity, and contributes to the organization's revenue cycle performance. Maintaining adequate coding staffing levels is critical to preventing coding backlogs, minimizing billing delays, and supporting timely claims submission.
About SUNY Downstate Health Sciences University
Public SUNY academic medical center providing health education, research, and hospital care to Brooklyn and New York City.
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