Outpatient Quality Reviewer
Core
Review outpatient coded cases for coding completeness and accuracy, identify payment opportunities, and provide expert coding advice to staff.
Role type
Outpatient Coding Quality Reviewer
Builds
Coding accuracy and compliance for outpatient services (Ancillary, ED, Same Day Surgery, etc.)
Domain
Healthcare Revenue Cycle / Medical Coding
Required skills
Outpatient coding expertise, CPT/HCPCS/ICD-10-CM/Modifier/APC code assignment, audit analysis, regulatory compliance (CMS/AHA/AMA), process improvement
Preferred skills
Bachelor's or Associate Degree
Technologies
CPT, HCPCS, ICD-10-CM, Modifier, APC
Responsibilities
Conduct quality reviews of outpatient records to validate code assignments; Provide audit feedback, coaching, and guidance to coding teams; Analyze audit results to identify trends for education and process improvement; Partner with cross-functional teams to resolve coding issues; Stay current on industry regulations and coding guidelines; Drive continuous improvement through training and process optimization