Outpatient Coding Quality Reviewer

About the role

R1 RCM is looking for an Outpatient Coding Quality Reviewer to review outpatient coded cases for completeness and accuracy. The role covers Ancillary, Emergency Department, Same Day Surgery, Observation, Wound Care, Professional Services, Interventional Cardiology and Interventional Radiology. It is a remote position.

Key responsibilities

• Review outpatient records and validate CPT, HCPCS, ICD-10-CM, modifier and APC code assignments
• Identify potential coding and APC/payment opportunities, research the supporting guidelines and communicate changes to the coder or quality reviewer
• Provide coding advice to coding staff and global quality reviewers, and relay coding education topics to the Manager of Outpatient Coding Quality
• Analyze audit results to find opportunities for education, process improvement and quality enhancement
• Partner with Quality, Education, Denials and Coding Operations teams to resolve coding issues and support revenue integrity
• Stay current on CMS, AHA, AMA and other regulatory requirements

Required profile

• High school diploma, GED or equivalent
• One or more active certifications: RHIT, RHIA, COC, CCS-P or CCSA
• Minimum of seven years of hospital outpatient coding experience, including Ancillary, ED, Same Day Surgery, Observation, Wound Care, E/M professional services, Interventional Cardiology and Interventional Radiology
• Bachelor's or Associate degree preferred

Required skills

• Coding knowledge: CPT, HCPCS, ICD-10-CM, modifiers and APCs
• Quality review and audit analysis

The base pay range for this US-based position is $28.24 - $40.21 per hour, depending on role, level, location, experience and education.