Job Description:
• Provide technical expertise in reviewing physician/provider documentation for outpatient surgery, observation, and potentially ambulatory clinic encounters
• Determine accurate diagnoses, procedures, APCs, modifiers, and identify NCCI and LCD/NCD edits to ensure proper reimbursement
• Utilize encoder software and online tools to assign ICD-CM, CPT/HCPCS, and APC codes; resolve system edits and support timely claims submission
• Apply coding guidelines from CMS, AHA Coding Clinic, AMA CPT, and AHIMA Standards of Ethical Coding
• Review patient records and related systems to determine all required codes, modifiers, and edits affecting reimbursement
• Interpret bundling/unbundling rules (NCCI), LCD/NCD edits, and payer policies
• Work internal/external outpatient claim edits; route non-coding edits to appropriate teams
• Maintain CEUs and current knowledge of changes in outpatient coding regulations
• Identify workflow or EMR issues impacting coding; escalate documentation or ethical concerns when needed
• Maintain knowledge of relevant laws, regulations, and ethical standards.
Requirements:
• Permanent U.S. work authorization required
• CCS, CCA or COC Certifications
• Three (3) years of current acute care outpatient surgery and observation coding experience required
• Extensive knowledge of medical terminology, anatomy and physiology, diagnostic/procedural coding, APC assignment, NCCI edits, and LCD/NCD edits
• Experience using encoder/grouping software and CAC preferred
• Ability to use standard computer applications, email, internet, and web-based tools
• Strong oral/written communication; able to work with diverse groups
• Ability to research, analyze, and integrate information from multiple sources
• Strong critical thinking, problem-solving, organization, and customer service skills; meets productivity requirements
• Adaptable, flexible, and able to prioritize in a virtual environment with minimal supervision
• Demonstrates integrity, professionalism, and alignment with Huron’s mission, vision, and values
• Encoder experience (3M/Solventum, Encoder Pro, Codify) preferred
• Epic, Cerner, and Meditech experience preferred.
Benefits:
• medical, dental and vision coverage
• Paid Time Off
• paid parental leave
• adoption assistance
• a 401(k) plan with a generous employer match
• employee stock purchase plan
• wellness programs
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