• Read and interpret all documents contained in the medical record to identify all diagnosis and procedures
• Consult with providers/staff for clarification when conflicting or ambiguous information is recorded
• Code-identified diagnosis and procedures following national and PHS coding guidelines
• Use Code Correct, Coding Institute Coding Alert, and current ICD-9/ICD-10 and CPT manuals
• Select principal diagnosis and procedure in accordance with coding standards, CMS requirements and knowledge of prospective payment systems
• Enter all missing charges into EPIC system, with careful attention to adding notes to clarify clinic charges on a non-clinic charging system
• Code outpatient, and ancillary records using ICD-10-CM and CPT-4 coding guidelines for correct APC/APG assignment. 
• Assign the Physician's Evaluation/Management service code. 
• Perform clinical and demographic abstracting in UDS and Meditech computer system. 
• Enter deficiencies in the chart tracking system. 
• Review charts for data retrieval for hospital/medical staff quality, risk and infection control activities

• Training of all coders in ICD-10-cm and documentation.
• Auditing of coding and documentation used for coding, including remote coding and CDM coders.
• Codes all phases of patient information including inpatient and rehab.
• Knowledgeably applies ICD 10-cm encoders and other references.
• Accurately assigns DRGs and monitors and audits assignment of DRG accuracy.
• Audit accuracy of coding of anyone in training.
• Develop training tools to train future coders.
• Assist Document Specialists with questions and reviews documentation worksheets for accuracy of documentation and coding.
• Work with other areas of the hospital assisting in review, corrections, rebills of coded accounts.
• Review and selectall ICD 10 and CPT code information in EPIC for operative procedures and inpatient visits in a timely manner. 
• Escalate any physician related issues.
• Review documentation and select/correct codes for PB and HB services including but not limited to infusion servces and radiation oncology in EPIC.
• Adheres to compliance regulations set by government, state, & the Cooper Health System to ensure guidelines are met.

Skills: ICD-10-CM Training Expertise, Auditing and Compliance, Coding Proficiency, DRG Assignment and Monitoring, Development of Training Materials, Documentation Review and Correction, Cross-Department Collaboration, EPIC System Proficiency

• Accurately prepares all inpatient and outpatient insurance and patient claims that need to be billed according to the proper method requested by each individual company for primary and secondary insurance in a timely manner. 
• Maintains productivity in line with department standards
• Prepares secondary insurance billing accounts. 
• Ensures correctness of all information when filing insurance claims
• Provide quality feedback as it relates to the quality, accuracy, and timeliness of other departments as it relates to the billing process.
• Keep accurate records of all patients, under scope of responsibility, which includes keeping accurate information on account activity
• Providing appropriate file documentation to include accurate assignment of payer class to maintain accurate records
• Familiar with regulatory charges issued by intermediaries and insurance companies to determine how charges could impact claims processing and communicate with manager such changes.
• Demonstrates a thorough knowledge and understanding of billing policies and procedures in performing job duties and instructing patients and hospital personnel
• Routinely using the Revenue Cycle Guidelines and other reference materials as necessary to ensure the proper course of action in billing, follow-up, and collections.
• Provides feedback to the Office Manager as to accuracy of coding as it impacts billing and reimbursement.
• Reports the status of all accounts under scope of responsibility including the timely response to all requests and inquiries by the Office Manager.
• Respond to all daily correspondence both written and oral
• Processes correct claims, i.e. late charges
• Utilizes the CPT, ICD10 manuals and continues to grow in the use of the computer system as its capabilities expand.

Skills: Insurance Claim Processing, Regulatory Knowledge, Attention to Detail, Revenue Cycle Management, Quality Assurance, Regulatory Compliance, Communication Skills, Technical Proficiency

• Learn CAN medical specialties and services offered.
• Provide feedback to providers and operational staff regarding denials, payments, coding, etc.
• Maintain communication by facilitating meetings and providing frequent updates
• Act as a resource for coding questions from a variety of departments including Revenue Cycle, Clinical Operations, HIM and EHR Support
• Assist in troubleshooting and/or conducting research when presented with difficult coding scenarios.
• Analyze supporting medical record documentation for professional services to ensure that appropriate ICD-10-CM, CPT, HCPCS codes are assigned according to established correct coding guidelines and standards of ethical coding.
• Perform ongoing review and tracking of insurance rejections/denials with coding discrepancies, contacting insurance companies when necessary.
• Consult with clinical providers for coding and documentation clarification when necessary.
• Conduct prospective and retrospective clinical documentation and coding reviews.
• Provide individual and group feedback and education to clinical providers, and other staff because of the coding reviews and identified coding trends, in accordance with the established compliance plan.
• Work with clinical operations and compliance staff to implement corrective action plans.
• Attend clinic and department staff meetings to disseminate information and to become familiar with operational issues within each business unit.
• Work in conjunction with clinical operations team to evaluate special requests for review of appropriate coding due to patient complaints, denials, rejections, incorrect coding, etc., and provide feedback to inquiring source.
• Analyzes information about patient treatment, diagnosis, and procedures to ensure proper coding guidelines are met.
• Demonstrates working knowledge of multiple coding systems, including ICD-10, Level 1 HCPCS, and Level 2 HCPCS.

Skills: Medical Coding Expertise, Coding and Compliance Consultation, Interdepartmental Communication, Insurance Denial Management, Troubleshooting and Research, Clinical Documentation Review, Education and Training, Operational Collaboration

• Reviews, analyzes, and approves codes for diagnostic and procedural information that determines Medicare, Medi-Cal and private insurance payments. 
• Perform ICD-10-CM, CPT and HCPCS coding for reimbursement. 
• Ensures compliance with established coding guidelines, third party reimbursement policies, regulations and accreditation guidelines. 
• Review ICD-10-CM, CPT and HCPCS codes against documented information for Dignity Health Medical Foundation clinical encounters. 
• Assures the final diagnoses and operative procedures as stated by the physician are valid and complete. 
• Reviews necessary information from health records to identify proper and congruent relationships between procedure and diagnosis codes utilizing EndCoder systems, LCD's, NCD's and modifier relationships.
• Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. 
• Open lines of communication with the health care professional and resolve discrepancies in coding practices and provide education 
• Performs a comprehensive review for the record to assure the presence of all component parts such as patient and record identification, signatures and dates where required, and other necessary data in the presence of all reports that appear to be indicated by the nature of the treatment rendered. 
• Analyzes provider documentation to assure the appropriate Evaluation & Management (E & M) levels are assigned using the correct CPT code using both 1995 and 1997 CMS guidelines for auditing.

Skills: ICD-10-CM, CPT, and HCPCS Coding Proficiency, Coding Compliance and Regulation Adherence, Documentation Review and Analysis, EndCoder Systems Proficiency, Provider Communication and Education, Evaluation & Management (E & M) Coding, Record Accuracy and Completeness, Problem-Solving and Discrepancy Resolution

• Able to be security checked t BPSS Standards
• Ability to assess data analytically
• Excellent IT skills and able to use systems and apps competently
• Good attention to detail and accuracy
• Confidentially, understanding you need to keep information secure
• Able to maintain target standards and follow processes
• Strong team player with a positive attitude
• Experience in medical information technology (with college-level courses in anatomy, physiology, medical terminology, ICDCM coding, and prospective payment)
• Knowledge of College-level courses in Anatomy & Physiology
• Evidence of successful completion of basic coding coursework (i.e. Stafford, AHIMA, AAPC etc.)

Qualifications: BA in Computer Science with 2 years of Experience

• Understanding of health insurance and medical costs.
• Knowledge of third-party billing regulations, professional operations, and third-party payer requirements.
• Able to communicate effectively.
• Detail-oriented and have strong organizational skills.
• Possess a strong work ethic and a high level of professionalism.
• Have proficient computer skills, with the ability to learn internal application systems.
• Current CPC or CCS-P certification required
• Excellent knowledge of CPT-4, ICD-9 and HCPC coding conventions required
• Experience in insurance billing, health information or ambulatory/clinic and hospital operations required

Qualifications: BS in Software Engineering with 3 years of Experience

• Working knowledge of medical codes involving selections of most accurate and description code using the ICD-9-CM, Volumes 1- 3, CPT, and HCPCS coding conventions
• Working knowledge of medical terminology, abbreviations, techniques and surgical procedures; anatomy and physiology
• Working knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for the assignment of diagnostic and procedural codes
• Effective communication skills
• Ability to communicate effectively with all levels within the organization
• Intermediate level of Microsoft Office systems including Excel and Word required
• Requires travel to meet with and educate providers in remote clinic locations
• Knowledge of CCS-A or CPC-A certification
• Working knowledge of Endcoder systems

Qualifications: BA in Information Technology with 4 years of Experience

• Experience interpreting a variety of instructions in written, oral, diagram, or schedule form.
• Must have advanced knowledge of Medical Terminology and excellent interpersonal skills and communication skills both written and oral.
• Previous experience capturing data and analyzing quality measures, case mix index, and health record documentation compliance.
• Skilled in data analysis, research, and error-correction
• Strong organizational and teamwork skills.
• Ability to effectively present information and respond to questions concerning statistics, coding, and transcription.
• Advanced computer skills in Microsoft programs, Word, Excel, Outlook and Electronic Medical Records (EMR), Meditech or EPIC
• Experience as an outpatient coder specializing in Same-Day or Outpatient Surgery records, Observation/Short stay records, Emergency Department records, and Ancillary records using ICD-10-CM and CPT codes.
• Knowledge of diagnoses and procedures in accordance with ICD-10-CM and CPT coding principles
• Problem-solving, Computer, Critical thinking skills
• Strong verbal and written communication skills

Qualifications: BS in Computer Engineering with 5 years of Experience

• Experience in pt. intake, scheduling, & multi-line phone systemLicensure:
• Good written and verbal communication skills; 
• Able to operate an electronic calculator and similar office equipment.
• Strong math skills and be able to perform financial calculations.
• Effective interpersonal relations skills for interfacing with all levels of hospital employees.
• Able to maintain effective relationships with staff & the ability to maintain the confidentiality of all information.
• Ability to work under stressful situations with time constraints & constant demands.
• Coding experience in an acute care facility
• Computer proficiency, able to research coding questions and utilize educational resources
• Independent, focused individual able to work remotely
• Both Inpatient and Outpatient cardiac and interventional radiology coding experience

Qualifications: BA in Data Science with 3 years of Experience