Coder Outpatient II

UMass Memorial Health•Worcester, MA

1d•$23 - $41

About The Position

The Coder Outpatient II interprets clinical and diagnostic documentation to process hospital and/or professional-fee charges for outpatient care. The role reviews medical records and related tests and reports, then assigns appropriate current-edition ICD-CM and CPT codes and modifiers. Depending on account type, the coder may also assign ICD-PCS codes in accordance with official coding guidelines and recognized reference materials. The position verifies that documentation supports assigned codes, helps resolve incomplete or missing chart documentation, and supports accurate and timely coding and billing. The coder participates in ongoing coding audits and performance management, maintains a coding accuracy rate of at least 95% and meets department productivity standards. The role stays current with coding updates, attends required training, supports documentation training and improvement efforts, communicates backlogs and documentation issues to the Manager, escalates unusual or questionable situations, and alerts management to coding irregularities. It adheres to applicable AHA, AMA, and CMS coding and billing regulations and coordinates with other coding personnel to support effective operations. The schedule is Monday through Friday, 6:00 a.m. to 10:00 a.m., identified as a four-hour day shift. The hiring range is $22.85–$41.14 based on a 40-hour full-time schedule; compensation for part-time or reduced schedules is prorated. A signing bonus may be available, with eligibility confirmed during the interview process.

Requirements

High school diploma or equivalent.
Knowledge of current-edition ICD-CM and CPT coding systems, as well as CCI edits.
Knowledge of third-party payer requirements and federal and state guidelines and regulations related to coding and billing practices.
Good interpersonal and communication skills, with professionalism.
Good customer service skills and ability to communicate efficiently.
Good organizational skills and attention to detail.
Ability to work independently within established guidelines.
Ability to organize and coordinate multiple functions and tasks.
Ability to problem-solve, organize, and prioritize workload to meet productivity benchmarks.
Ability to withstand significant ongoing pressure and deal with individuals tactfully, discreetly, and diplomatically.

Nice To Haves

Medical coding certification.
Training in medical terminology from an accredited program, with completion and passing of a certification program within one year of hire; recognized programs include AHIMA and AAPC.
Certified Coding Specialist (CCS) or Certified Coding Specialist–Physician (CCS-P) certification.
Three years of medical abstraction and outpatient coding experience or related work experience.

Responsibilities

Review medical records, tests, and reports to determine appropriate current-edition ICD-CM and/or CPT codes and modifiers; assign ICD-PCS codes when applicable under official coding guidelines.
Verify that documentation substantiates assigned codes.
Help resolve incomplete or missing chart documentation to expedite coding and billing.
Participate in the continuous coding audit and performance management program.
Maintain coding accuracy of at least 95% and meet department productivity standards.
Attend required annual training classes and coding in-services to stay current with regulations and coding guidelines.
Participate in improvement efforts and provide documentation training to medical and clinical staff regarding coding practices and guidelines.
Notify the Manager when backlogs arise or necessary documents are incorrect or delayed.
Refer unusual or questionable situations to the direct Manager.
Alert management to coding irregularities or trends that conflict with policies and procedures.
Follow coding and billing regulations established by the AHA, AMA, and CMS.
Communicate on an ongoing basis with other coding personnel to support operational effectiveness and efficiency.
Keep current with coding updates and information related to correct coding.