Ambulatory Coder

The Ambulatory Coding and Reimbursement Specialist is responsible for reviewing, analyzing, and accurately coding ambulatory and/or hospital-based encounters. This role performs initial charge review for E/M visits, diagnostic tests, and procedures across multiple specialty departments to determine the appropriate assignment of CPT, ICD-10, HCPCS codes, and modifiers for reporting physician services to third-party payers. The Specialist ensures all coding aligns with established coding standards, regulatory requirements, and reimbursement policies.

Essential Duties and Responsibilities:

Analyzes provider documentation to assure the appropriate Evaluation Management levels are assigned using the correct CPT and current Evaluation and Management Guidelines

Interprets outpatient office visit notes and charge documents to determine services provided and accurately assign CPT , Modifiers, and ICD-10 coding to these services.

Performs comprehensive review of encounter note to assure all vital information such as patient identification, signatures, attestation, and dates are present in the record.

Evaluate documentation for consistency and adequacy. Ensure diagnosis accurately reflects the care and treatment rendered.

Monitors and follows up to ensure all services billed are captured and coded.

Follows and adheres to all WWT policies such as Coding Audit Policy and Physician Coding Query In-Basket Policy

Provide real time feedback to providers on all coding changes and trends via EPIC in basket message

Regularly participate and engage in coding team meeting.

Reviews all physician documentation to ensure compliance with third party and regulatory guidelines.

Works in coordination with other members of the physician’s office/departments as necessary.

Collaborates with Coding Management for special coding and billing projects if assigned.

Apply coding knowledge and skills to resolve coding denials from payers and works with management and various departments.

Resolving coding denials assigned by applying coding knowledge and skills.

Maintains active coding credentials and CEU’s required for coding roles.

Performs other related duties as required and assigned.

Knowledge, Skills Abilities

Knowledge and understanding of medical coding and billing systems and regulatory requirements

Communication - communicates clearly and concisely, verbally and in writing.

Persistence – comfortable pursuing, rebutting and escalating issues as appropriate.

Goal-oriented – holds him/herself accountable to achieving shared professional and personal goals.

Customer orientation - establishes and maintains long-term customer relationships, building trust and respect by consistently meeting and exceeding expectations.

Interpersonal skills – establishing and maintaining effective working relationships with employees, and external parties.

PC skills - demonstrates high proficiency in Microsoft Office applications, especially Microsoft Excel, and others as required.

Writing skills –advanced writing skills with ability to present a compelling argument, punctuate properly, spell correctly and transcribe accurately.

Education/Experience :

Certified professional coder CCS-P, CPC, RHIT or RHIA through AAPC or AHIMA with a minimum of two years’ experience with CPT/ICD-10 coding of multispecialty services preferred. Responsible for maintaining continuing education per certification requirements.

Clear understanding of protocols and procedures in a medical office including health information management, confidentiality, and safety.

Organize and prioritize responsibilities while remaining flexible to changing demands.

Excellent written and oral communication skills, with the ability to interact with patients, families, staff and others.

Strong analytical skills and attention to detail

Ability to establish priorities and work independently

Must have high level of discretion and judgment.