Purpose of the Position
The Outpatient Health Information Coding and Reimbursement Specialist assigns diagnosis and procedural codes to hospital outpatient medical records to ensure proper reimbursement and data collection across Cape Cod Healthcare facilities.
Key Responsibilities
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Assign, analyze, sequence, and validate codes using automated encoders and coding resources.
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Apply Official Coding Guidelines, CCI edits, anatomy, physiology, and medical terminology for complex outpatient encounters including oncology/infusion clinics, outpatient surgery, observation encounters, and injection/infusion procedures.
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Review medical documentation to assign diagnoses, procedures, levels, and modifiers for hospital reimbursement.
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Update charges in hospital billing systems with correct codes, dates, and modifiers.
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Ensure compliance with coding, regulatory, and reimbursement standards.
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Query physicians or healthcare providers for clarification or additional documentation.
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Maintain a 95% accuracy rate and meet weekly productivity standards.
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Track productivity logs and report to the Coding Manager.
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Assist in onboarding and developing new coding staff.
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Pursue ongoing professional development to maintain coding certification.
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Identify workflow issues and recommend solutions to improve coding efficiency.
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Handle system and coding edits or denials and communicate trends to management.
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Provide service excellence in alignment with hospital customer service standards.
Qualifications
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Certifications: Active CCS, CPC, RHIT, or COC.
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Experience:
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Minimum 1 year acute care hospital outpatient coding experience for complex encounters.
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At least 6 months PC Windows experience.
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Skills:
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Proficient in reading, writing, and communicating in English.
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Successful passage of Medical Record Department Outpatient Coding Exam (≥80%).
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About Cape Cod Healthcare
Cape Cod Healthcare is committed to providing exceptional patient care and accurate health information management across its facilities. The organization emphasizes professional growth, compliance, and high-quality services for all patients and stakeholders.