Coding Specialist - Outpatient Telecommute

Reports to the Coding Manager. Responsible for reviewing outpatient clinical documentation to extract data and assign appropriate ICD-10-CM, CPT, and HCPCS codes in accordance with the ICD-10-CM Official Guidelines for Coding and Reporting and AHA Coding Clinic guidance. Ensures medical record documentation supports all assigned codes and resolves coding-related claim edits using 3M 360 Finder (e.g., CCI, NCD, OCE).

The role supports timely coding and billing processes by monitoring outpatient uncoded reports, maintaining required productivity and accuracy standards, and collaborating with physicians and internal partners as needed.

Brown University Health employees are expected to role model the organization's values of Compassion, Accountability, Respect, and Excellence, which guide everyday interactions with patients, customers, and colleagues.

Employees are also expected to demonstrate the organization's Core Success Factors, including:

• Instilling trust and valuing differences
• Patient and community focus
• Collaboration

• Reviews and enters coded/abstracted outpatient encounter information into 3M 360 Finder, assigning accurate APCs and resolving all coding edits.
• Applies National Correct Coding Initiative (NCCI) edits and medical necessity requirements.
• Resolves accounts within the claims edit database and assigns injection and infusion codes for observation patients.
• Meets or exceeds established productivity standards while maintaining a minimum coding accuracy rate of 95%.
• Assigns E/M, ICD-10-CM, CPT, and chargemaster codes for outpatient clinic visits, ensuring documentation supports all code assignments.
• Reviews provider-entered diagnosis and procedure codes for accuracy and documentation support.
• Utilizes 3M tools to identify and resolve NCCI edits prior to final billing.
• Identifies and reports documentation deficiencies to the responsible physician.
• Follows Rhode Island Hospital Facility Coding Guidelines for adult patients and the 1995 Evaluation and Management Guidelines for patients under 18.
• Monitors and resolves rejected accounts from Claims Edit Reports and eClinicalWorks error reports within established timeframes.
• Researches and resolves coding conflicts related to chargemaster issues, medical necessity, and other billing discrepancies.
• Escalates complex coding issues to a coding validator or supervisor as appropriate.
• Reviews outpatient uncoded reports and resolves aged or inappropriate charges.
• Updates patient financial records in Patient Management and Patient Accounting systems and follows established rebilling procedures.
• Performs related clerical duties as required.
• Maintains current knowledge and expertise relevant to outpatient coding practices and regulatory requirements.

• High school diploma or equivalent required.
• Successful completion of a formal coding education program.
• Ability to read and interpret outpatient medical record documentation involving clinic services, ancillary services, and endoscopy procedures.
• Active coding certification required (AHIMA or AAPC).

• One to two years of outpatient coding or billing experience required.
• Demonstrated ability to meet and maintain productivity and quality standards.

• Prolonged periods of sitting while reviewing medical records.
• Must be able to lift up to 25 pounds, bend, stoop, stretch, and use step stools for filing.
• Ability to work under stressful conditions to meet accounts receivable, productivity, and accuracy expectations.

• Performs duties independently within established departmental policies and procedures.
• Refers complex issues or policy clarifications to the supervisor as needed.

• None