Community Health Network

Medical Billing and Coding

• Perform patient chart reviews to ensure the appropriateness and completeness of diagnostic coding with evidence based on CMS HCC standards.
• Timely, accurate, and complete review of patient charts following patient encounters, utilizing a variety of technical platforms to complete workflows.
• Validating diagnosis codes representing patient conditions along with necessary MEAT documentation.
• Ensuring coding is consistent with guidelines from regulatory entities.
• Conducting audits to meet compliance with ACA standards.
• Creating post-visit queries with follow-up.
• Collaborating with CDI team members, particularly with clinical findings.
• Contributing to the provider education body of work, participating in pre-encounter reviews as needed.

Risk Adjustment Coder

Director

• Ensure timely and accurate preparation of Medicare, Medicaid, and Champus cost reports
• Monitor regulatory changes, assess financial impacts, and develop optimization strategies for public payer reimbursement programs
• Assist with financial reporting, analysis, and budgeting for accounts receivable, contractual allowances, uncompensated care, and third-party settlement estimates
• Serve as a key member on internal and external committees, collaborating with leadership to drive compliance and financial performance

Director, Reimbursement

System Administrator

• User and application requirements analysis
• Application development, support, and maintenance
• Data and database analysis and reporting
• Monitor and manage incident tickets for assigned modules/databases through ServiceNow
• Ensure timely resolution and adherence to service level expectations
• Serve as a functional expert for troubleshooting and problem-solving
• Provide guidance to customers on interpreting information
• Maintain a strong understanding of assigned applications and related technologies
• Lead application upgrades
• Perform project planning, feasibility analysis, and implementation strategies
• Share knowledge with team members and mentor colleagues as needed

Risk Adjustment Coder

Director, Reimbursement

Senior System Administrator – SuccessFactors, LMS