OP Medical Coder

Role Overview

OP Medical Coder at NMC Healthcare. Location not specified in source material.

Role Purpose

Review and code outpatient medical encounters using ICD-10-CM, CPT, and HCPCS code sets, ensuring compliance with billing guidelines, accurate documentation sequencing, and organizational quality standards.

Key Responsibilities

Documentation & Review

• Review physician documentation, medical records, and outpatient encounters.
• Identify missing, unclear, or conflicting documentation and escalate queries appropriately.

Coding & Assignment

• Assign accurate ICD-10-CM, CPT, and HCPCS codes.
• Ensure accurate sequencing of diagnoses and procedures.
• Validate diagnoses, procedures, modifiers, and medical necessity where applicable.

Quality & Compliance

• Apply outpatient coding and billing guidelines correctly.
• Review coding edits, denials, and documentation-related issues.
• Follow HIPAA/privacy and organizational compliance requirements.
• Maintain productivity and accuracy targets.
• Keep up to date with annual coding guideline and code-set changes.

Skills & Competencies

• Knowledge of ICD-10-CM, CPT, and HCPCS coding.
• Understanding of outpatient/ambulatory coding guidelines.
• Medical terminology and anatomy knowledge.
• Strong attention to detail and analytical skills.
• Experience with EHR/EMR and coding software (preferred).

Qualifications & Experience

• CPC, CCS, CCA, or equivalent certification (often preferred or required, depending on employer).