Outpatient Coding Specialist

The Department of Health Information Management at SUNY Downstate Health Sciences University is seeking a full-time TH Medical Records Specialist / Outpatient Coding Specialist.

Job Summary

The Outpatient Coding Specialist is responsible for reviewing, analyzing, and accurately coding outpatient medical records in accordance with established coding guidelines, regulatory requirements, and institutional policies. The incumbent abstracts relevant clinical information and assigns appropriate diagnosis and procedure codes to ensure accurate documentation, coding compliance, and appropriate reimbursement for outpatient services.

The position requires knowledge of medical terminology, clinical documentation, outpatient coding methodologies, and applicable healthcare reimbursement guidelines. The Outpatient Coding Specialist works collaboratively with physicians, clinical departments, and Health Information Management staff to resolve documentation deficiencies, maintain coding accuracy, and support the integrity of the institution's health information and revenue cycle processes.

Key Responsibilities & Duties

• Review and analyze outpatient medical records to accurately abstract clinical information and assign appropriate ICD-10-CM, CPT, and applicable HCPCS Level II codes in accordance with established coding guidelines.
• Assign accurate and complete diagnosis and procedure codes based on physician documentation, clinical findings, and applicable outpatient coding conventions.
• Ensure coding accuracy, consistency, and compliance with official coding guidelines, payer requirements, institutional policies, and applicable federal and state regulations.
• Review clinical documentation for completeness, specificity, and accuracy to support appropriate code assignment and reimbursement.
• Identify incomplete, conflicting, or unclear documentation and initiate appropriate physician queries to obtain clarification in accordance with established documentation integrity and compliance standards.
• Apply outpatient coding guidelines, including appropriate sequencing of diagnoses and procedures, medical necessity requirements, and applicable coding edits.
• Maintain current knowledge of coding classification systems, regulatory updates, reimbursement methodologies, and changes to coding guidelines.
• Support accurate and timely coding of outpatient encounters to facilitate efficient billing, claims processing, and revenue cycle operations.
• Identify coding discrepancies, documentation deficiencies, and potential compliance concerns and communicate findings to the Coding Manager or appropriate departmental leadership.
• Collaborate with physicians, clinical staff, Health Information Management personnel, and other hospital departments to resolve coding and documentation issues.
• Utilize electronic health records, coding applications, and other health information systems to review documentation, assign codes, and maintain accurate coding records.
• Maintain established departmental standards for coding accuracy, productivity, turnaround times, and quality.
• Ensure the confidentiality, security, and integrity of patient health information in accordance with HIPAA regulations and institutional policies.
• Participate in coding audits, quality assurance activities, staff education, and process improvement initiatives, as assigned.
• Perform other job-related duties as assigned and/or required.

The outpatient coder role is essential to the timely and accurate assignment of diagnosis and procedure codes for outpatient services. Accurate coding ensures compliance with federal and state regulations, supports appropriate reimbursement, maintains data integrity, and contributes to the organization's revenue cycle performance. Maintaining adequate coding staffing levels is critical to preventing coding backlogs, minimizing billing delays, and supporting timely claims submission.

Required Qualifications

• High School Diploma or equivalent.
• Minimum of one (1) year of direct professional medical coding experience in a hospital or outpatient healthcare setting.
• Current professional certification in at least one of the following:
  • Registered Health Information Administrator (RHIA) – American Health Information Management Association (AHIMA).
  • Registered Health Information Technician (RHIT) – American Health Information Management Association (AHIMA).
  • Certified Coding Specialist (CCS) – American Health Information Management Association (AHIMA).
  • Certified Professional Coder (CPC) – American Academy of Professional Coders (AAPC).
• Demonstrated knowledge of ICD-10-CM, CPT, and applicable HCPCS Level II coding systems and official outpatient coding guidelines.
• Knowledge of medical terminology, anatomy and physiology, and clinical documentation relevant to outpatient coding.
• Ability to review and interpret medical records, abstract clinical information, and independently assign appropriate diagnosis and procedure codes.
• Understanding of coding compliance standards, documentation requirements, and patient confidentiality regulations.
• Strong analytical skills, attention to detail, organizational skills, and the ability to work independently while maintaining accuracy and meeting established deadlines.
• Effective written and verbal communication skills, including the ability to communicate with physicians and other healthcare professionals regarding clinical documentation and coding matters.

Preferred Qualifications

• Bachelor's Degree in Health Information Management, Health Information Technology, Health Sciences, or a closely related field.
• Three (3) to five (5) years of direct medical coding experience in an acute care hospital or hospital-based outpatient setting.
• Experience coding outpatient hospital services, including ambulatory surgery, emergency department, outpatient procedures, or other hospital-based outpatient encounters.
• Experience utilizing electronic health record systems, computerized coding applications, and coding reference tools.
• Familiarity with outpatient reimbursement methodologies, coding edits, payer requirements, and coding compliance audits.
• Experience working collaboratively with physicians and clinical departments to resolve documentation deficiencies and improve coding accuracy.