About this role

We are seeking an experienced Facility Outpatient Coding Specialist to support a large academic university health system and Level I Trauma Center. This role is focused exclusively on outpatient coding edits and claim review activities , ensuring accurate code assignment, modifier usage, National Correct Coding Initiative (NCCI/CCI) compliance, and medical necessity validation across multiple outpatient specialties.

The ideal candidate will have strong outpatient edit experience, a thorough understanding of payer guidelines, and proficiency with both Cerner and 3M coding applications.

Key Responsibilities

- Review and resolve outpatient coding edits for facility-based services.
- Analyze and correct NCCI/CCI edits to ensure coding compliance and claim accuracy.
- Review and apply appropriate modifiers based on documentation and payer requirements.
- Validate and address medical necessity edits in accordance with CMS and payer guidelines.
- Collaborate with coding, compliance, revenue cycle, and clinical teams to resolve coding discrepancies.
- Maintain coding quality standards while meeting productivity and turnaround time expectations.
- Stay current with coding regulations, payer policies, and industry best practices.
- Support accurate reimbursement through compliant coding and edit resolution processes.

Required Qualifications

- Minimum 2 years of facility outpatient coding experience .
- Demonstrated experience working outpatient coding edits, including: NCCI/CCI edits
- Modifier review and application
- Medical necessity review

- Experience supporting multiple outpatient specialties.
- Strong understanding of CMS regulations, payer policies, and outpatient reimbursement methodologies.
- Experience using Cerner and 3M coding systems (required).
- Excellent analytical, problem-solving, and communication skills.
- Ability to work independently in a remote environment while maintaining quality and productivity standards.

Preferred Qualifications

- Certified coding credential such as: CPC
- CCS
- CCS-P
- RHIT
- RHIA

- Experience supporting academic medical centers or Level I Trauma Centers.
- Prior experience with outpatient facility claim editing and revenue integrity workflows.

Training & Schedule

- Initial Training: First week requires availability Monday through Friday, 8:00 AM to 4:00 PM MST .
- Post-Training Schedule: Flexible scheduling may be available based on business needs, performance, and management approval.

Work Environment

This is a remote position supporting a university-based health system and Level I Trauma Center. The role requires attention to detail, strong coding knowledge, and the ability to effectively manage outpatient coding edit workflows in a fast-paced healthcare environment.