Medical Billing and Coding

• Reviews documentation and assigns appropriate ICD-10, CPT and HCPCS codes.
• Assigns appropriate primary diagnosis after deciding what was chiefly responsible for the encounter.
• Assigns appropriate modifiers according to guidelines.
• Finalizes the appropriate data for accounts.
• Clarifies documentation or diagnosis by communicating with the physician.
• Ensures weekly, monthly, and quarterly department goals are met.
• Makes recommendations to the Billing and Coding Manager for process and quality improvement.
• Maintains knowledge of current coding rules and trends for coding types assigned by attending seminars, workshops and watching webinars.

Medical Coder

• Assigns accurate ICD diagnosis codes, using compliant documentation.
• Assigns accurate CPT/HCPCS codes to records, using compliant documentation.
• Applies knowledge of Coding Guidelines to select the appropriate diagnosis code.
• Uses available research and reference tools to understand the disease process and diagnosis.
• Interprets physician documentation within the coding guidelines and obtains clarification from physicians regarding vague or ambiguous record documentation.
• Enhances coding knowledge and skills with continuing education activities as described in HIM.COD.003 policy and by reviewing pertinent literature.

Behavioral Health Coder

• Reviewing patient records, doctor's notes, and other relevant documentation to extract information about diagnoses, procedures, and treatments.
• Determine which diagnostic and procedural information is necessary for accurate coding of an authorization.
• Assign appropriate ICD-10, CPT, and HCPCS codes based on the information found in the medical records.
• Verifying the correctness of assigned codes, ensuring they align with coding guidelines and regulations, and identifying any discrepancies or errors.
• Communicating with physicians, clinical stakeholders and other teams such as surgical scheduling and authorization management to clarify any ambiguities in the documentation or coding.
• Ensuring the security and confidentiality of patient information as mandated by HIPAA.

Coding Specialist – Pre-Service

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – Cardiology

• Independently perform complex, specialty-specific professional fee coding (CPT/HCPCS and ICD-10-CM) for physician services rendered in both office and hospital settings, ensuring expert application of modifiers and E/M guidelines
• Perform entry-level facility coding for simple outpatient encounters (e.g., diagnostic imaging, labs) and basic inpatient services (e.g., uncomplicated admissions, short stays) using ICD-10-CM and ICD-10-PCS, where applicable
• Ensure all coding adheres strictly to official guidelines (e.g., provided by AAPC or AHIMA), federal regulations (CMS), and organizational compliance standards
• Identify the need for formal clinical queries for documentation clarification when necessary for professional or facility records
• Maintain high accuracy and productivity standards appropriate to the complexity of the assigned workload
• May provide informal guidance to new coding staff on professional coding nuances

Coder II – ENT, Audiology

• Process claims to appropriate primary, secondary, and/or tertiary insurance company according to insurance guidelines
• Perform follow-up on unpaid insurance accounts identified through aging reports
• Process appeals when appropriate
• Process refund requests
• Identify trends, and carrier issues relating to billing and reimbursements, report findings to leadership
• Maintain Privacy & Confidentiality of patient information and organizational operations
• Responsible for learning, understanding and following payer guidelines
• Reallocate misapplied payments and adjustments
• Work special assignments when needed

Medical Billing & Collections Specialist

• Reviews case documentation to confirm patient demographics and enter insurance information received for every case.
• Reviews completed patient reports to enter the appropriate diagnosis codes in accordance with established SOP's and healthcare guidelines.
• Maintains regulatory compliance to all applicable regulatory requirements (CLIA, NYS, CAP, FDA, ISO, etc.).

Certified Coder I

•Analyze, audit and resolve claims outstanding, denied, or incorrectly paid
•Review and respond to payer correspondence.
•Submit appeals as needed for denied claims.
•Contact insurance companies and navigate payer websites in order to secure and expedite insurance payments.
•Resolves patient billing inquiries.
•Document in detail all actions taken in accounts receivable system.
•Meet productivity expectations as outlined by supervisor.
•Recognize, document and notify Team Lead of trends resulting in nonpayment or incorrectly paid claims.
•Answer and resolve inbound calls from insurance carriers.
•Participate in process improvement initiatives as needed.
•Keep current with Medicare and other third party administrators regulations and procedures.
•Manage any special projects requested by supervisor or team lead.
•Must be able to perform the essential functions of this position with or without reasonable accommodation.

Medical Billing Insurance Specialist

• Works in collaboration with physicians
• Review medical record to abstract proper code assignment
• Assign ICD-10 CM/PCS codes to outpatient, emergency room, and professional services
• Responsible for reporting any safety-related incidents

Coder 2

• Responsible for assisting the coding department with the day-to-day non-coding duties support activities
• Assigns codes to office-based visits and procedures using the International Classification of Diseases (ICD-10-CM), Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS)
• Resolve coding edits to assure accurate and complete claims submission
• Sequences diagnoses and procedure codes as outlined in CPT, ICD-10-CM, and HCPCS Coding Guidelines while adhering to local and national governmental payer guidelines
• Reviews all clinician documentation to support assigned codes in the health information record
• Follows up and obtains clarification of inaccurate documentation as appropriate
• Codes risk adjustable encounters, resolves CRMs, and trends coding denials, as assigned
• Conducts formal coding and documentation reviews, clinician reviews and quality reviews, as assigned
• Assists with coding research functions and education activities
• Creates clinician coding and documentation education based on query trends or ad-hoc requests
• Adheres to the organization and departmental guidelines, policies, and protocols.
• Abides by Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
• Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement
• Maintains confidentiality of patient.

Physician Support Coder

• Reviews, interprets, and abstracts clinical documentation from inpatient and outpatient hospital records
• Codes complex orthopedic surgical cases across multiple subspecialties
• Applies appropriate DRG and/or APC assignment methodologies
• Ensures coding accuracy and compliance with regulations
• Utilizes hospital EMR and coding systems to capture required clinical and demographic data
• Collaborates with physicians and clinical staff for documentation improvement
• Meets or exceeds established productivity and quality benchmarks

Facility Coder II

• Assign accurate CPT, HCPCS, and ICD-10 codes for all services performed at BHC facilities
• Apply appropriate modifier usage based on payer and service requirements
• Ensure documentation supports medical necessity, procedural complexity, and level of services
• Apply correct diagnosis sequencing and body-part specificity required for WC claims
• Support WC-specific documentation requirements, including injury dates. Causality, and treating physician narratives
• Collaborate with billing teams to ensure correct claim formats, attachments, and WC payer rules are met
• Ensure coding compliance with CMS, AMA, NCCI, and OIG guidelines
• Participate in internal and external coding audits , implement corrective actions as needed
• Identify coding trends that impact denials, underpayments, or compliance risk
• Provide feedback and education to provider to improve documentation and coding accuracy
• Assumes other responsibilities as appropriate to the position and organizational needs

Certified Medical Coder

• The Certified Medical Coder is responsible for accurate, compliant, and timely coding of professional and facility pain management services
• Assign accurate CPT, HCPCS, and ICD-10 codes for all services performed at BHC facilities
• Apply appropriate modifier usage based on payer and service requirements
• Ensure documentation supports medical necessity, procedural complexity, and level of services
• Apply correct diagnosis sequencing and body-part specificity required for WC claims
• Support WC-specific documentation requirements, including injury dates, causality, and treating physician narratives
• Collaborate with billing teams to ensure correct claim formats, attachments, and WC payer rules are met
• Ensure coding compliance with CMS, AMA, NCCI, and OIG guidelines
• Participate in internal and external coding audits, implement corrective actions as needed
• Identify coding trends that impact denials, underpayments, or compliance risk
• Provide feedback and education to provider to improve documentation and coding accuracy

Certified Medical Coder – Temporary Contract

• Evaluate medical records and provide clinical and surgical abstraction
• Accurately code diagnostic and procedural information
• Consult with medical providers for record clarification
• Ensure compliance with coding rules and regulations
• Compile reports and tabulate data from medical records
• Identify validation edits and ensure accurate coding
• Work independently under regular supervision

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