HCC Outpatient Coder

  • MaineHealth
  • Scarborough, ME, USA
  • Jun 23, 2022
Healthcare IT

Job Description


  • Hierarchical Condition Categories - Full remote schedule
  • Position Summary
    • This is the second level of a 4-tier career path. Under the general direction of the Coding Director, this position is responsible for the accurate assignment of ICD10-CM and CPT-4 coding of diagnoses and procedures for outpatient medical records in multiple different outpatient settings including Provider Based Outpatient Hospital Clinics, , Provider Based Clinics (inclusive of E/M, Coding for both inpatient and outpatient professional procedures), IV therapy, and other areas as needed. Position includes performing abstracting to determine accuracy and completeness of the outpatient record, utilizing Epic EMR systems and additional external software systems to compile data. The HCC Outpatient Coder evaluates medical necessity and Correct Coding Initiative edits and resolves them accurately. The HCC coder reviews medical record documentation to evaluate diagnosis that meet the reportable MEAT criteria associated with HCC coding. Data reported is used to meet licensure requirements, statistical purposes and reimbursement purposes.
  • Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: Associates degree in science field strongly preferred with completion of an accredited program through AHIMA or AAPC.
    • License/Certifications: RHIT, RHIA, CCS, CCA, CPC, CPC-H, or CRC credential required.
    • Experience: Minimum of two (2) years of multi-specialty coding experience, with CPT/ICD-9-CM/HCPCS/modifier coding for physician professional charges . Specific experience with Risk Adjusted coding in an acute care setting preferred. Preferred prior experience coding E/M's, Outpatient Hospital Clinics, Professional CPT's, radiology and simple visit coding.
    • Proficiencies: Demonstrated knowledge of ICD-9-CM (ICD-10-CM/PCS), CPT-4 and HCPCS coding guidelines and principles required. Employee has the ability to demonstrate competence and knowledge-base through the utilization of a standardized test with a minimum of 95% accuracy while meeting productivity requirements. Advanced knowledge of auditing concepts and principals as well as regulatory requirements pertinent to HCC coding.
    • Specialized Knowledge: Strong ability to apply broad guidelines to specific coding situations, independently, utilizing discretion and a significant level of analytical ability. Strong oral and written communication skills required.

Additional Information

MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org