Senior Outpatient Coder

Description Senior Outpatient Coder Position Details: Full-Time Remote Reports to Coding Operations Manager You must reside in one of these states to be eligible for this position: Arkansas    California    Kentucky Massachusetts Nevada    New Mexico Oregon     Utah     Tennessee Texas     Wyoming Job Summary: The Senior Coder supports assigned inpatient and/or outpatient coding operations through day-to-day workflow leadership and may provide oversight of coding quality, coding edits, auditing, and staff education. Assigned functions may include inpatient, observation, emergency department, ambulatory surgery, ancillary, clinic, and other hospital-based coding services. The position supports Revenue Cycle Operations with special projects, including denial review, appeals, discharge-not-final-billed management, regulatory and payer edit review, and process improvement efforts designed to meet organizational goals while promoting accurate, complete, and compliant coding and billing. Duties and Responsibilities: Provides day-to-day leadership and operational support for assigned inpatient and/or outpatient coding workflows, work queues, facilities, and coding staff, consistent with delegated authority. Provides direct support to Coding Management, including process improvement, denials, special projects, coding edits, auditing, staff education, and other duties as assigned. Applies current official coding guidelines and authoritative guidance, including ICD-10-CM/PCS, CPT, HCPCS, UHDDS, Coding Clinic, CMS payment rules, and applicable payer requirements. Maintains at least 95% coding accuracy, or another threshold established by Coding Leadership, using the organization's approved audit methodology. Monitors coder productivity and quality at established intervals and provides timely, objective feedback, coaching, and education as directed by Coding Management. Ensures encounters processed by the coding team include an appropriate documented claim-hold reason before the account appears on the DNFB report. Collaborates with the CDI/Audit team to confirm second-level review is completed for applicable HAC, PSI, and Never Event cases in accordance with established workflows. Tracks and trends post-discharge coding queries, supports timely resolution, and provides feedback and education to ensure queries are non-leading, supported by the health record, and compliant with organizational policy and applicable guidance. Ensures accounts are not final billed until required documentation is available and assigned codes are supported by the health record, consistent with organizational policy and applicable billing requirements. Coordinate workflow improvements with HIM Operations Team(s). Assists in developing, implementing, and monitoring coding policies and procedures that support accurate coding, appropriate reimbursement, and compliance with federal and state laws, regulations, official coding guidelines, and payer requirements. Supports effective collaboration between Coding and CDI staff while maintaining role-appropriate accountability and compliant query practices. Adheres to the AHIMA Standards of Ethical Coding, the organizational code of conduct, and applicable compliance policies, and promotes compliant coding practices within assigned workflows. Maintains Discharged Not Final Billed goals established by Coding Leadership without compromising coding accuracy, documentation requirements, or compliance. Ensures coding policies related to HIM, Revenue Cycle, and Compliance are implemented and monitored within assigned areas. Implements HIM related projects at the direction of Coding Leadership. Supports Quality, Risk Management, Case Management, and other departments regarding HIM and coding matters within the scope of the role. Assists HIM, Coding, and CDI Leadership with the development and implementation of coding and CDI policies and procedures. Monitors and communicates changes in federal and state laws, regulations, accreditation standards, official coding guidance, CMS NCCI/OCE/MUE edits, and payer requirements that affect Coding and HIM operations. May develop and deliver staff education, coaching, and reference materials based on audit findings, coding-edit trends, denial trends, regulatory changes, and identified knowledge gaps; documents education as required. May research, review, resolve, and trend coding edits, including NCCI, OCE, MUE, encoder, claim-scrubber, and payer-specific edits; validates that any modifier or code change is supported by the health record and applicable guidance. May perform or support prospective, concurrent, and retrospective coding audits using an approved methodology; documents findings, identifies trends and potential overpayments or underpayments, and escalates compliance concerns through established channels. Protects the confidentiality, integrity, and security of protected health information and accesses only information necessary to perform assigned duties in accordance with HIPAA and organizational policy. Promptly reports suspected coding, billing, privacy, or compliance concerns through established channels and supports corrective action; does not alter the health record or direct unsupported coding. Knowledge, Skills and Abilities: Extensive knowledge of OPPS, IPPS, UHDDS, Coding Clinic, official coding guidelines, CMS NCCI/OCE edits, and applicable reimbursement methodologies. Microsoft Office (Word, One Note, Excel, Outlook, PowerPoint) Ability to interpret audit findings, coding-edit logic, and payer requirements and translate findings into staff education and process improvement. Ability to maintain objectivity, confidentiality, and accurate audit documentation and to communicate compliance concerns through established channels. Excellent verbal and written communication skills. Ability to meet assigned deadlines. Extensive knowledge of Anatomy & Physiology, Medical Terminology, and Pathophysiology. Work Experience, Education and Certifications: EDUCATION: CCS Credential, RHIT or RHIA EXPERIENCE: 5-10 years progressive HIM coding management experience within an acute care hospital setting. Extensive experience with Revenue Cycle Operations including acute care coding CERTIFICATION/LICENSURE: RHIA or RHIT or CCS SOFTWARE/HARDWARE: 3M 360 experience required Travel Requirements: Expected travel is up to 10% at the request of leadership. Benefits: Competitive salary and benefits package. Opportunities for professional development and advancement. Supportive work environment with a collaborative team. Comprehensive healthcare coverage. Retirement savings plan. Paid time off and flexible scheduling options. Student loan repayment program.