Job Description
Certified Professional Coder, Outpatient Billing
Position Summary
This role is responsible for ensuring accurate, compliant, and complete coding of professional outpatient encounters in a high-volume urgent care environment. This role reviews provider documentation, validates and corrects CPT® and ICD-10-CM code selection, queries providers for missing or unclear documentation, and ensures all claims meet CCI, payer, and outpatient coding requirements prior to billing. This role also plays a key role in supporting provider coding and documentation audits and manual coding activities required during system downtime or special operational needs.
Key Responsibilities
Documentation Review & Coding Validation
Review clinical documentation to confirm all services rendered are documented completely and accurately prior to billing.
Validate provider-selected CPT® and ICD-10-CM codes to ensure they are fully supported by medical record documentation.
Make coding corrections in accordance with official coding guidelines, payer policies, and organizational standards.
Coding Accuracy & Compliance
Ensure claims comply with National Correct Coding Initiative (NCCI/CCI) edits, modifier usage rules, and outpatient coding guidelines.
Apply payer-specific coding and documentation requirements to support clean claim submission.
Maintain compliance with CMS, state, and commercial payer regulations.
Provider Queries & Collaboration
Query providers to obtain missing, incomplete, or unclear documentation needed for accurate coding and billing.
Communicate coding-related questions and feedback to providers in a clear, professional, and educational manner.
Partner with Billing, A/R, and Revenue Cycle teams to resolve coding-related claim issues.
Provider Education & Improvement
Identify trends or recurring documentation and coding issues impacting reimbursement or compliance.
Recommend provider education opportunities to improve documentation quality and coding accuracy.
Assist with internal and external coding and documentation audits as requested.
Manual Coding & Special Projects
Perform manual coding of encounters based on medical records during system downtime, paper chart usage, or other business continuity needs.
Support special coding projects, backlogs, or payer initiatives as assigned.
Productivity, Documentation & Continuous Improvement
Meet established productivity, accuracy, and turnaround time standards.
Maintain detailed documentation of coding decisions, provider queries, and corrections.
Stay current on coding updates, payer policy changes, and urgent care–specific guidelines.
Required Qualifications
High school diploma or equivalent required; Associate degree or higher preferred.
Active Certified Professional Coder (CPC®) credential required.
2+ years of professional outpatient coding experience.
Strong working knowledge of CPT®, ICD-10-CM, modifiers, CCI edits, and outpatient coding rules.
Preferred Qualifications
Experience coding urgent care, emergency medicine, or high-volume ambulatory encounters.
Familiarity with California payer requirements.
Experience working within EHR and professional billing systems.
Additional coding credentials (e.g., CPMA, COC) a plus.
Key Competencies
Strong attention to detail and analytical skills
Solid understanding of clinical documentation and coding guidelines
Effective written and verbal communication with providers and staff
Professional judgment and compliance-focused mindset
Ability to manage high-volume work independently
Working Conditions
Office or remote environment; flexibility for onsite work dictated by business needs