Certified Outpatient Coder – Cardiac Surgery

Jefferson Health Plans•Philadelphia, PA

1d•Hybrid

About The Position

We are seeking an experienced Certified Outpatient Coder specializing in cardiac surgery to support accurate coding, billing, compliance, and revenue cycle integrity for a high-volume cardiovascular surgical program. This role is responsible for reviewing outpatient medical records and assigning appropriate ICD-10-CM, CPT, HCPCS, and modifier codes related to cardiac surgery procedures, diagnostic testing, and associated clinical services. The ideal candidate has advanced knowledge of cardiovascular anatomy, cardiac surgical procedures, outpatient facility and/or professional fee coding guidelines, and payer-specific requirements. This position works collaboratively with physicians, APPs, clinical staff, billing teams, and revenue cycle leadership to ensure coding accuracy, optimize reimbursement, and maintain regulatory compliance.

Requirements

High school diploma or equivalent required; Associate’s degree preferred.
Current coding certification required, including one of the following: AAPC Certified Professional Coder (CPC), AHIMA Certified Coding Specialist (CCS), Certified Outpatient Coder (COC) preferred.
Minimum of 3 years of outpatient coding experience required.
Minimum of 2 years of cardiovascular or cardiac surgery coding experience strongly preferred.
Strong knowledge of: ICD-10-CM, CPT and HCPCS coding, Cardiac surgery terminology and anatomy, Medicare and commercial payer regulations, Outpatient facility and/or professional fee coding guidelines.
Experience with Epic and encoder software preferred.
Excellent analytical, organizational, and communication skills.
Ability to work independently while maintaining high accuracy and productivity standards.

Nice To Haves

Coding experience in: CABG procedures, Valve repair/replacement, TAVR/TMVR, ECMO, Thoracic aortic procedures, Minimally invasive cardiac surgery, Cardiac outpatient testing and follow-up procedures.
Experience supporting academic medical centers or large cardiovascular programs preferred.

Responsibilities

Review and accurately code outpatient cardiac surgery encounters, procedures, diagnostic studies, and related services using ICD-10-CM, CPT, and HCPCS coding systems.
Assign appropriate modifiers and ensure compliance with NCCI edits, Medicare guidelines, and payer-specific rules.
Interpret operative reports, physician documentation, catheterization reports, imaging studies, and procedural documentation related to cardiovascular surgery.
Abstract coding and clinical data into the electronic medical record and billing systems.
Identify documentation deficiencies and communicate with providers regarding clarification or education opportunities.
Maintain productivity and quality standards established by department leadership.
Support denial management and appeals by reviewing coding-related denials and providing corrective recommendations.
Participate in internal coding audits, compliance initiatives, and process improvement efforts.
Remain current on coding updates, payer regulations, and cardiovascular coding changes.
Collaborate with cardiac surgery leadership, revenue cycle teams, and compliance departments to improve coding accuracy and charge capture.