When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.
Under the supervision of the Outpatient Coding Manager and OP Coding Supervisor, the Senior Coding Specialist is responsible for the accurate, timely, and compliant assignment of ICD-10-CM, CPT, HCPCS Level II, modifiers, revenue codes, and APC classifications for complex hospital outpatient encounters. The Senior Coding Specialist reviews outpatient records and clinical documentation to ensure appropriate code assignment, regulatory compliance, and reimbursement integrity across a variety of outpatient services, including clinic, interventional radiology, cardiology, infusion, observation, procedural, and ancillary departments.
Serving as a subject matter expert, the Senior Coding Specialist works closely with Coding Leadership, OP Coding Validators, Revenue Integrity, Compliance, and Clinical Operations teams to promote coding uniformity, consistency, and accuracy in accordance with ICD-10-CM and CPT coding conventions, Official Coding Guidelines, CMS regulations, Federal and State requirements, American Hospital Association (AHA) guidance, Coding Clinic publications, National Correct Coding Initiative (NCCI) edits, and payer-specific policies.
In addition to performing advanced coding functions, the Senior Coding Specialist provides mentoring, education, quality review support, and guidance for complex coding scenarios. The Senior Coding Specialist is responsible for meeting or exceeding established productivity and quality standards while supporting timely coding, billing, denial prevention, compliance initiatives, and organizational revenue cycle objectives.
Job Description:
Essential Duties & Responsibilities including but not limited to:
Advanced Facility Coding
1. Review and assign ICD-10-CM, CPT, HCPCS Level II, modifiers, revenue codes, and APC classifications for complex outpatient hospital encounters.
2. Accurately code facility services within interventional radiology and cardiology
3. Interpret coding guidelines, payer policies, CMS regulations, and official coding conventions to ensure compliant code assignment.
4. Apply National Correct Coding Initiative (NCCI), Medically Unlikely Edits (MUEs), OPPS regulations, and payer-specific requirements.
5. Evaluate documentation to ensure services are appropriately supported and billed.
6. Assist with coding quality reviews and audits of outpatient facility coding staff.
7. Serve as a coding resource and mentor for coding team members.
8. Provide education regarding coding updates, regulatory changes, and department policies.
9. Assist with onboarding and training of new coders.
10. Support continuing education initiatives within the coding department.
11. Function as a lead resource for escalated coding questions and complex coding scenarios.
12. Provide recommendations regarding workflow improvements and coding best practices.
13. Participate in departmental projects, system implementations, and process improvement initiatives.
Minimum Qualifications:
Education: Hospital Coding
· Associate degree in Health Information Management or Completion of an AHIMA or AAPC Coding Certification program, preferred
· High School Diploma or equivalent, required.
Licensure, Certification & Registration: Hospital Coding
· RHIA, RHIT, or CCS from AHIMA or a CPC or COC from AAPC, required
· CIRCC from AAPC, required
Experience: Hospital Coding
· Minimum 5 years of ICD-10-CM, CPT/HCPC Outpatient Facility coding assignment, required
· Minimum of 2-4yrs of Interventional and Cardiovascular Facility coding, preferred
· Prior experience performing coding audits, quality reviews, or mentoring preferred.
· Experience in large health systems or academic medical centers preferred.
Required Skills, Knowledge & Abilities:
· Working knowledge of the complexities of interventional radiology and cardiovascular procedures including cardiac catheterizations, vascular surgeries, injections…