Outpatient Coder

This is a Fully Remote Job

About Our Client:

The organization is a 501(c)(3) non-profit multi-service entity governed by Federally Qualified Health Centers (FQHCs). It operates as an FQHC-led accountable care organization (ACO) and a Management Services Organization (MSO) serving FQHCs. The organization negotiates value-based payer contracts, manages compliance, financial, and population health functions, and provides various operational, financial, and technological services including electronic health record implementation and pharmacy operations. It is the largest Medicaid ACO in Massachusetts and has national business offerings.

About the Opportunity:

The OUTPATIENT CODER will join a developing coding team within the billing and credentialing service to review ambulatory medical records for FQHC clients. Reporting to the Director of Revenue Integrity, this role ensures that billed codes are accurately supported by clinical documentation and interprets medical record data for payer processing. The position is critical to maintaining coding compliance and supporting accurate revenue capture.

Responsibilities:

• Assign diagnosis codes (ICD-10) and procedure codes (CPT/HCPCS) based on medical documentation
• Complete coding promptly to meet billing deadlines
• Resolve incomplete or missing documentation to expedite billing
• Communicate with healthcare providers to clarify coding issues
• Perform claim edit corrections and review denials related to coding errors
• Identify and report coding or documentation trends that may risk revenue
• Stay current with coding guidelines, compliance policies, and industry changes
• Perform other duties as assigned

Requirements:

• Knowledge of ICD-10-CM, CPT, HCPCS coding systems and CCI edits
• Understanding of third-party payer requirements and coding regulations
• Familiarity with official coding and reporting guidelines
• Knowledge of medical record content and management
• Experience or education with electronic medical records
• Medical terminology proficiency
• Understanding of health information laws and patient confidentiality
• Proficiency in Microsoft Office applications
• Flexibility to adapt to changing business needs
• Strong interpersonal and communication skills
• Ability to take ownership for accurate and timely completion of tasks
• Willingness to learn new software and systems
• Problem-solving skills to identify causes and prevent recurrence
• Persistence in overcoming challenges
• Ability to remain stationary for 50-75% of the time

Desired Skills:

• Familiarity with the MassHealth ACO program
• Knowledge of Federally Qualified Health Centers
• Experience with anti-racism activities or lived experience with racism

Qualifications:

• High School Diploma or equivalent
• CPC Certification
• 3 to 5 years of outpatient CPT/HCPCS coding experience, preferably in multi-specialty settings
• Prior experience with Epic software preferred

Pay Range and Compensation Package:

• The pay range and compensation package for this role will be determined based on the candidate's experience, skills, and other relevant factors.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.