Coding Specialist CCS
Mount Sinai Medical Center, Miami Beach, FL, United States
Job Description Summary
The Coding Outpatient Specialist is responsible for reviewing, coding, and abstracting outpatient medical records by accurately selecting and documenting appropriate ICD-10-CM diagnosis and CPT procedure codes. This includes a wide range of outpatient services such as clinic visits, same-day surgeries, diagnostic testing, oncology, wound care, and other ancillary services. The role ensures compliance with CMS regulations, payer‑specific guidelines, and organizational policies to support accurate reimbursement and data integrity.
The specialist evaluates clinical documentation within the electronic health record (EHR) to determine correct code assignment, verify medical necessity, and ensure all rendered services are appropriately captured. This position collaborates with providers and clinical staff to clarify documentation, resolve coding discrepancies, and promote best practices in outpatient coding and documentation.
Key responsibilities include maintaining high standards of coding accuracy and productivity, supporting compliance initiatives, and staying current with coding updates, regulatory changes, and payer requirements.
This role requires strong knowledge of outpatient coding guidelines, excellent attention to detail, critical thinking skills, and the ability to manage multiple accounts efficiently in a fast‑paced environment. This is a per diem position, with availability expected for up to 20 hours or more per week, as needed.
Position Responsibilities
Performs coding and abstracting on outpatient medical records by selecting and documenting ICD-10-CM Diagnoses and CPT procedure codes.
Assigns correct CM Diagnoses and CPT with coding accuracy rate of 95% or greater.
Performs abstracting of coding and clinical data (i.e. discharge disposition, discharge date, patient type, etc.) with an accuracy rate of 95% or greater.
Codes/abstracts 24 Outpatient diagnostic/Breast Center records per hour.
Codes 12 Emergency department records per hour.
Codes 24 PHP & Outpatient REHAB Series records per hour.
Codes 10 Oncology per hour.
Codes 4.5 Ambulatory, GI's and Observation per hour.
Process EPIC Dashboard all work Q's-OP Priority, Coding Review Needed, Failed Claims within our 2 day Billed Hold. Process all emails within a 24 to 48 response time.
Maintains current status of Coding Credentials, by annually submitting proof of compliance with AHIMA requirements.
Completes 30 hours of Continued Education annually.
Refers queries to physicians and questions to supervisors as appropriate, complying with all internal audit requirements (i.e. review charts for Complication/Comorbidity compliance).
Performs daily verification of records received, add notes to Accounts for ALL Charts.
Reviewing ALL Scanned and/or Electronic Order on each record.
Qualifications
License/Registration/Certification:
CCS, RHIT, RHIA or eligible to test for one of these. Certification must be obtained within 12 months of employment.
Education:
Associates degree in Health Information Management or completion of Coding Specialist Program or equivalent years of work experience.
Experience:
1 year of coding ICD-10-CM and CPT-4 preferred.
Benefits
Health benefits
Life insurance
Long‑term disability coverage
Healthcare spending accounts
Retirement plan
Paid time off
Pet Insurance
Tuition reimbursement
Employee assistance program
Wellness program
On‑site housing for select positions and more!
#J-18808-Ljbffr
The Coding Outpatient Specialist is responsible for reviewing, coding, and abstracting outpatient medical records by accurately selecting and documenting appropriate ICD-10-CM diagnosis and CPT procedure codes. This includes a wide range of outpatient services such as clinic visits, same-day surgeries, diagnostic testing, oncology, wound care, and other ancillary services. The role ensures compliance with CMS regulations, payer‑specific guidelines, and organizational policies to support accurate reimbursement and data integrity.
The specialist evaluates clinical documentation within the electronic health record (EHR) to determine correct code assignment, verify medical necessity, and ensure all rendered services are appropriately captured. This position collaborates with providers and clinical staff to clarify documentation, resolve coding discrepancies, and promote best practices in outpatient coding and documentation.
Key responsibilities include maintaining high standards of coding accuracy and productivity, supporting compliance initiatives, and staying current with coding updates, regulatory changes, and payer requirements.
This role requires strong knowledge of outpatient coding guidelines, excellent attention to detail, critical thinking skills, and the ability to manage multiple accounts efficiently in a fast‑paced environment. This is a per diem position, with availability expected for up to 20 hours or more per week, as needed.
Position Responsibilities
Performs coding and abstracting on outpatient medical records by selecting and documenting ICD-10-CM Diagnoses and CPT procedure codes.
Assigns correct CM Diagnoses and CPT with coding accuracy rate of 95% or greater.
Performs abstracting of coding and clinical data (i.e. discharge disposition, discharge date, patient type, etc.) with an accuracy rate of 95% or greater.
Codes/abstracts 24 Outpatient diagnostic/Breast Center records per hour.
Codes 12 Emergency department records per hour.
Codes 24 PHP & Outpatient REHAB Series records per hour.
Codes 10 Oncology per hour.
Codes 4.5 Ambulatory, GI's and Observation per hour.
Process EPIC Dashboard all work Q's-OP Priority, Coding Review Needed, Failed Claims within our 2 day Billed Hold. Process all emails within a 24 to 48 response time.
Maintains current status of Coding Credentials, by annually submitting proof of compliance with AHIMA requirements.
Completes 30 hours of Continued Education annually.
Refers queries to physicians and questions to supervisors as appropriate, complying with all internal audit requirements (i.e. review charts for Complication/Comorbidity compliance).
Performs daily verification of records received, add notes to Accounts for ALL Charts.
Reviewing ALL Scanned and/or Electronic Order on each record.
Qualifications
License/Registration/Certification:
CCS, RHIT, RHIA or eligible to test for one of these. Certification must be obtained within 12 months of employment.
Education:
Associates degree in Health Information Management or completion of Coding Specialist Program or equivalent years of work experience.
Experience:
1 year of coding ICD-10-CM and CPT-4 preferred.
Benefits
Health benefits
Life insurance
Long‑term disability coverage
Healthcare spending accounts
Retirement plan
Paid time off
Pet Insurance
Tuition reimbursement
Employee assistance program
Wellness program
On‑site housing for select positions and more!
#J-18808-Ljbffr