Introduction
The Outpatient Health Information Coding and Reimbursement Specialist ensures that medical records are coded accurately and completely for proper reimbursement and compliance. As an Outpatient Health Information Coding and Reimbursement Specialist, you will analyze, assign, and validate diagnostic and procedural codes using standard guidelines and hospital systems. This role supports timely claim submission, minimizes denials, and maintains high data accuracy to strengthen hospital operations and financial performance.
Key Responsibilities of an Outpatient Health Information Coding and Reimbursement Specialist
The Outpatient Health Information Coding and Reimbursement Specialist reviews medical record documentation to determine the correct codes for diagnoses and procedures. Using official coding guidelines, CCI edits, and clinical understanding, you will ensure compliance and accuracy for outpatient encounters such as surgery, oncology, infusion, and observation services.
Main Duties Include:
- Assign and validate CPT, ICD-10-CM, and HCPCS codes for complex outpatient services.
- Review medical records for accuracy and completeness of documentation.
- Ensure compliance with federal, state, and hospital coding regulations.
- Query physicians for clarification when documentation is insufficient.
- Maintain a coding accuracy rate of 95% or higher through audits and reviews.
- Meet productivity and timeliness standards for claim submissions.
- Abstract relevant information into hospital billing and coding systems.
- Assist in training and mentoring new coding staff as needed.
The Outpatient Health Information Coding and Reimbursement Specialist also collaborates with management to address denials, improve efficiency, and resolve coding-related issues in alignment with departmental goals.
Qualifications for an Outpatient Health Information Coding and Reimbursement Specialist
To succeed as an Outpatient Health Information Coding and Reimbursement Specialist, you must demonstrate advanced coding knowledge, accuracy, and the ability to manage multiple tasks efficiently.
Required Qualifications:
- Proficiency in reading and interpreting English medical documentation.
- Active certification such as CCS (AHIMA), CPC (AAPC), RHIT (AHIMA), or COC (AAPC).
- Minimum of 1 year of acute care hospital coding experience in complex outpatient encounters (surgery, oncology, infusion, observation).
- Successful completion of a Medical Record Department Outpatient Coding Exam with a score of 80% or higher.
- Minimum of 6 months of experience using Windows-based PC systems.
- Strong understanding of anatomy, physiology, and medical terminology.
- Excellent attention to detail and communication skills.
Work Environment and Benefits
The Outpatient Health Information Coding and Reimbursement Specialist position at Cape Cod Hospital offers a Monday–Friday schedule, 8 a.m.–4 p.m., with no weekends or holidays. Remote candidates are considered. Employees enjoy a professional, collaborative environment that values growth, education, and excellence in patient care.
Cape Cod Healthcare provides competitive benefits, professional development opportunities, and a supportive workplace dedicated to service quality and employee success.
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