Medical Coding / Medical Coder-- (E/M) Outpatient Coder

Role & Responsibilities

• Review and analyze provider documentation for

  outpatient encounters

  , including office visits, urgent care, telehealth, and same-day procedures.
• Assign accurate and compliant

  CPT, HCPCS, and ICD-10-CM

  codes, with a focus on

  Evaluation and Management (E/M)

  services.
• Determine correct

  E/M levels

  based on official coding guidelines (

  1995, 1997, and 2021 E/M Guidelines

  ).
• Validate

  medical necessity

  and ensure documentation supports billed services.
• Abstract coded data and enter it accurately into the

  Electronic Health Record (EHR)

  or coding software system.
• Collaborate with

  providers, billing, and compliance teams

  to clarify documentation or resolve discrepancies.
• Participate in

  coding audits

  and assist in implementing corrective actions when needed.
• Stay updated on

  current coding regulations

  , payer policies, and organizational standards.
• Support the

  revenue cycle process

  by ensuring accurate and timely coding to minimize claim denials.
• Maintain strict

  confidentiality

  and

  HIPAA compliance

  at all times.

Preferred Candidate Profile

• Education:

  Bachelor’s or Master’s degree in

  Health Information Management

  ,

  Health Sciences

  , or a related field.

• Certifications (any one required):

• CPC® (Certified Professional Coder)

  – AAPC

• COC® (Certified Outpatient Coder)

  – AAPC

• CCA® (Certified Coding Associate)

  – AHIMA

• Experience:

• Minimum

  2+ years

  of experience in

  outpatient coding

  , specifically

  E/M coding

  .
• Experience working with

  EHR systems

  such as

  Epic, Cerner, or Athenahealth

  preferred.

• Technical Skills:

• Strong knowledge of

  CPT®, HCPCS, and ICD-10-CM

  coding systems.
• Understanding of

  E/M documentation guidelines

  and

  payer requirements

  .
• Proficiency with

  coding software

  and

  Microsoft Office tools

  .

• Soft Skills:

• Excellent

  attention to detail

  and

  analytical thinking

  .
• Strong

  communication

  and

  team collaboration

  skills.
• Ability to work independently and maintain

  accuracy under pressure

  .
• Commitment to

  confidentiality

  ,

  compliance

  , and

  continuous learning

  .