Outpatient Payment Integrity Production Coder
职位总结：MedReview 正在寻找一个室外支付完整性生产编码器。室外支 देय完整性制作编码器负责完成要求级的室外患者编码审查，以确定不准确的编码，未支持的账单，文档缺口和潜在的过度支付。该角色通过应用室外患者代码专业知识，客户支付政策，CMS 指导，CPT/HCPCS 要求，修改规则，NCCI 编辑以及医疗记录文件标准来确保审计结果是准确的，可辩护的，并持续恢复客户节省的行为。关键责任 · 通过医疗记录，详细的账单，申请线路，付款人要求，CPT/HCPCS 指导方针，ICD-10-CM 指南，收入代码，修改规则，NCCI 编辑，APC/EAPG 逻辑和支持文件进行室外患者编程审查。·验证是否有文档支持计费诊断服务以及是否报告了正确的程序代码，调整器，单位，收入代号和支付组合。·确定编码差异，未经支持的服务，分类，不适当使用，错误的程序修改符选择，单元错误，文档缺陷和其他室内病人支付完整性发现。· 根据所分配的要求，应对审计目标指导，工作辅助，付款人政策，编码层次和文档标准进行一致。· 文件审计理性合理化清楚且可辩护，包括支持结果，未经支持的发现，代码变更，修改者问题，文档缺口以及用于支持审查决定的参考资料。· 满足生产，质量，转换时间和一般专业期望，同时保持准确性和一致性。· 将复杂的编码，付款人的政策，退还，定价，工作流或文档问题向适当的领导，管理员或主题专家提出。· 参与培训，校准审查，质量反会议和目标更新活动以支持持续应用外科医院审计概念。·保持对外医生编码指导方针，付款人政策，CMS 指导，NCCI 修改，LCD/NCD,适应变更要求以及有关外科医院支付完整性所需的退还方法的最新知识。
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Position Summary:
MedReview is looking for a Outpatient Payment Integrity Production Coder. The Outpatient Payment Integrity Production Coder is responsible for completing claim-level outpatient coding reviews to identify inaccurate coding, unsupported billing, documentation gaps, and potential overpayments. This role supports payment integrity operations by applying outpatient coding expertise, client payer policy, CMS guidance, CPT/HCPCS requirements, modifier rules, NCCI edits, and medical record documentation standards to ensure audit findings are accurate, defensible, and client savings consistently recovered.
Key Responsibilities
· Perform outpatient coding reviews using medical records, itemized bills, claim lines, payer requirements, CPT/HCPCS guidance, ICD-10-CM guidelines, revenue codes, modifier rules, NCCI edits, APC/EAPG logic, and supporting documentation.
- Validate whether billed outpatient services are supported by documentation and whether the correct procedure codes, modifiers, units, revenue codes, and billing combinations were reported.
- Identify coding discrepancies, unsupported services, unbundling, inappropriate modifier usage, incorrect procedure code selection, unit errors, documentation deficiencies, and other outpatient payment integrity findings.
- Apply approved audit target guidance, job aids, payer policy, coding hierarchy, and documentation standards consistently across assigned claims.
- Document audit rationale clearly and defensibly, including supported findings, unsupported findings, code changes, modifier issues, documentation gaps, and references used to support the review decision.
- Meet production, quality, turnaround time, and general professional expectations while maintaining accuracy and consistency.
- Escalate complex coding, payer policy, reimbursement, pricing, workflow, or documentation questions to the appropriate lead, manager, or subject matter expert.
- Participate in training, calibration reviews, quality feedback sessions, and target refreshers to support consistent application of outpatient audit concepts.
- Maintain current knowledge of outpatient coding guidelines, payer policies, CMS guidance, NCCI edits, LCDs/NCDs, modifier requirements, and reimbursement methodologies relevant to outpatient payment integrity.
Required Qualifications
· Current nonexpired coding certification credential required: CPC, COC, CCS, RHIT, RHIA or equivalent.
- Minimum of 3 years of outpatient coding experience required.
- Strong knowledge of CPT, HCPCS, ICD-10-CM, revenue codes, modifier usage, NCCI edits, outpatient documentation standards, and payer-specific coding requirements.
- Experience reviewing outpatient facility claims, medical records, operative reports, emergency department records, observation records, ancillary services, injections and infusions, surgical procedures, or other outpatient service lines.
- Ability to interpret payer policy, CMS guidance, LCDs/NCDs, coding references, and documentation requirements and apply them to claim-level reviews.
- Ability to distinguish between coding validation and payment integrity auditing by evaluating what was billed, what is supported, and why a billed service may be incorrect or unsupported.
- Strong written communication skills with the ability to document clear, concise, and defensible audit rationale.
- High attention to detail, analytical thinking, sound judgment, and ability to work independently in a production environment.
- Ability to meet productivity and quality expectations while managing multiple claims, priorities, and deadlines.
- Proficiency with Microsoft Outlook, Word, Excel, coding tools, claim review platforms, and electronic medical record documentation systems.
Preferred Qualifications
· Previous payment integrity, audit, outpatient facility audit, payer review, or claims review experience preferred.
- Experience with outpatient reimbursement methodologies such as APC, EAPG, OPPS, multiple procedure reductions, packaging, bundling, and payer-specific reimbursement rules.
- Experience using coding references, encoder tools, 3M, TruCode, WebStrat, payer portals, claim systems, or similar applications.
- Optum platforms experience
Production and Quality Expectations
The Outpatient Payment Integrity Production Coder is expected to complete assigned claims in accordance with approved workflow, target guidance, quality standards, and turnaround time expectations. The coder must maintain accurate notes, apply coding guidance consistently, participate in quality review and calibration activities, and respond to feedback in a timely and professional manner. Production expectations may vary based on claim complexity, target type, medical record size, payer requirements, and training status.
Core Competencies
· Outpatient coding accuracy
- Policy and documentation interpretation
- Clear audit rationale writing
- Production discipline and time management
- Attention to detail
- Adaptability in a growing outpatient audit program
Compliance and Professional Standards
This position requires adherence to company policies, client requirements, confidentiality standards, HIPAA requirements, coding compliance expectations, and professional standards for accurate and ethical claim review. The coder is expected to maintain confidentiality, exercise objective judgment, and support accurate payment outcomes through consistent application of approved coding and audit criteria.
Salary - $58,000 - $65,000
Originally posted on Himalayas