Medical Billing and Coding

• Codes and abstracts diagnoses and patient information from outpatient ancillary encounters and enters data into the hospital information system
• Verifies abstracted hospital information fields for accuracy and completeness
• Monitors daily data printout to assure completion of all outpatient records requiring coding and abstracting
• Communicates with physicians or physician office staff when documentation is unclear or insufficient to complete the coding process
• Maintains coding proficiency through self-directed continuing education

HIM Coding Specialist I

• Accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes
• Abstracting demographic and physician data to meet both internal and regulatory requirements for reporting utilizing the hospital’s abstracting system
• Collaborating with providers via email, phone call, or in person to educate or discuss coding requirements
• Ensuring compliance with AAPC/AMA CPT Guidelines, AAPC/AMA Coding Clinic, ICD 10-CM CMS, HCAI, and NorthBay Health coding guidelines
• Working in an environment focused on delivering high-quality patient care

ED Professional Fee Coder

• Code medical records to validate ICD-10-CM codes for PACE Risk Adjustment
• Meet department production and quality standards
• Research regulatory guidelines for supporting documentation
• Prepare coding reports using excel
• Prepare oral and/or written reports of work activity to Supervisor
• Be responsible and accountable for maintaining the confidentiality, integrity, and availability of protected health information.
• Follow HIPAA security policies and procedures affecting your job, and report any suspected or actual violation or breach
• Other duties as assigned

Risk Adjustment Coder

• Review patient claims for accuracy and completeness and proactively obtain any missing payer information for inclusion
• Appeal medical insurance claim denials in a timely manner
• Ensure compliance with procedures and coding guidelines
• Answer patient inquiries related to coverage denials and coding reviews for resubmissions as necessary.
• Communicate with clinical leadership and third-party billing company on issues regarding CPT & ICD-10 coding selections

Medical Biller, Coder

• play a crucial role in accurately translating medical procedures and diagnoses into ICD 10, CPT and HCPCS codes
• accurately and timely for professional surgery charges in the outpatient and inpatient settings
• effectively communicate with providers via email, query, phone call or in person to educate or discuss coding requirements
• work is performed using the approved classification Coding systems to include the modifiers
• carry out work in accordance with the rules, regulations and coding conventions of the AAPC/AMA CPT Guidelines, AAPC/AMA. American Hospital Association (Coding Clinic), ICD 10-CM CMS, HCAI, and NorthBay Healthcare coding guidelines

Professional Surgical Coder II

• Conducts timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls
• Identifies missing payments from the health plan and initiates tracking procedures
• Reviews incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed
• Identifies pending claims and determines next steps required to obtain reimbursement for claim
• Uses existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary
• Follows up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
• Monitors incoming messages from providers and responds to the provider or escalates the request to the appropriate team member
• Identifies claims with more complex issues and escalate them to the appropriate team member for resolution as needed
• Research health plan reimbursement policies and procedures, clinical guidelines, coding, and CCI edits to ensure claims are billed appropriately
• Communicate effectively with insurance companies, healthcare providers, and their billing staff to resolve claims issues and answer inquiries
• Document all interactions and updates in the claims management system
• Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
• Prepare and submit reports on claim follow-up activities and status updates to management as requested
• Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
• Stay updated on changes in insurance policies, regulations, and industry standards
• Must meet quantitative production standard of working 100 – 150 claims per week
• Attend departmental and company meetings as required
• Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
• Investigate and resolve discrepancies or issues related to claims processing and payment
• Work with other team members and departments ensure proper claim submission
• Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
• Participate in training and development opportunities to stay current with best practices and industry trends

Medical Billing Coordinator

• Assigns either ICD-10-CM and PCS codes for inpatient visits or assigns ICD-10 CM codes, professional and technical EM levels, and surgical CPT codes for physician visits at commercially reasonable production rates and at a consistent 95% or greater quality level.
• Validates either MS-DRG or APC assignments, as applicable.
• Abstracts clinical data appropriately.
• Mitigates either hospital inpatient coding-related claims scrubber edits or professional and technical coding-related claims scrubber edits.
• Tolerates short-term assignments for up to two different clients.
• Participates in client and Savista meetings and training sessions as instructed by management.
• Maintains an ongoing current working knowledge of the coding convention in play at client assignments.
• Performs other related duties as required.

Inpatient Coding Specialist

• Provide accurate and timely revenue cycle and account management services to OBS member clients
• Process claims, manage accounts receivable, and maintain documentation in compliance with payer guidelines and OCHIN systems
• Investigate and resolve claim denials, identify trends, and contribute to process improvements that enhance reimbursement outcomes
• Communicate effectively with team members and stakeholders to clarify billing requirements and contribute to a cooperative work environment
• Use OCHIN tools and processes to track deadlines and plan billing activities for timely and efficient task completion
• Demonstrate foundational understanding of the U.S. healthcare system and apply knowledge of OCHIN solutions to billing operations

Medical Billing Specialist – Acute Care

• Maximize reimbursement and minimize denials by assuring that proper coding guidelines have been met.
• Work within the Providence footprint states: AK, MT, CA, OR, TX, NM, and WA.

Associate Coder

• Provide accurate and timely revenue cycle and account management services to OBS member clients.
• Contribute to OCHIN’s key performance indicators by identifying and resolving claims issues.
• Maintain compliance with payer requirements.
• Engage in continuous process improvement.
• Manage self-pay accounts and customer inquiries.
• Handle daily claims production including printing, mailing, and preparing documentation for clean claim submission.

Medical Billing Specialist

• Mentor other team members in the details of their assigned health plan, providing answers to questions and direction when needed
• Review provider escalations and provider resolution or escalation to management as needed
• Review complex patient accounts requiring identification of duplicate claims, corrected claims, overpayments, underpayments, and other issues and work them to resolution
• Conduct timely and accurate follow-up on professional services claims to ensure all requested information has been submitted and claims are being processed utilizing payor portals, secure chat, secure messaging, and telephone calls
• Identify missing payments from the health plan and assists in researching/locating payments
• Review incoming correspondence from health plans and takes appropriate action or escalates to designated team members as needed
• Identify pending claims and determines next steps required to obtain reimbursement for claim
• Use existing queries to review limited new denials for processing errors, appropriately assigns a status based on review, corrects any internal errors and resubmits claims as necessary
• Follow up with insurance carriers, providers, or other stakeholders to gather additional information or documentation required for claims resolution
• Monitor incoming messages from providers and respond to the provider or escalates the request to the appropriate team member
• Assist with special claims research projects as assigned
• Document all interactions and updates in the claims management system
• Maintain accurate records of claim status, actions taken, and resolutions utilizing established policies and procedures
• Prepare and submit reports on claim follow-up activities and status updates to management as requested
• Ensure all claims follow-up activities comply with company policies, industry regulations, and legal requirements
• Stay updated on changes in insurance policies, regulations, and industry standards
• Must meet quantitative production standard of working 75 - 125 claims per week
• Attend departmental and company meetings as required
• Identify and report trends which could have an overall negative impact on claim payments such as processing errors, denials, or billing issues
• Investigate and resolve discrepancies or issues related to claims processing and payment
• Work with other team members and departments ensure proper claim submission
• Identify and recommend process improvements to enhance the efficiency and effectiveness of the claims follow-up process
• Participate in training and development opportunities to stay current with best practices and industry trends.

Medical Billing Team Lead

• Review medical documentation and health information within various electronic medical or health systems.
• Assign applicable codes such as clinical modification (ICD-10-CM), current procedural terminology (CPT), evaluation and management (E&M), and healthcare common procedure coding system (HCPCS) while adhering to productivity and quality standards for the area(s) of assignment or specialty (Facility or Professional).
• Focus on specialties including, but not limited to: Professional Multispecialty E&M, Facility Emergency Room (non-Single Path), and Outpatient Visits (Facility or Professional).
• Resolve complex edits and alerts with consistent accuracy using current guidelines for the area(s) of assignment or specialty.
• Handle edits such as: Simple Visit, Local and National Coverage Determination, and other Related Edits.
• Communicates with physicians, providers, and external departments regarding documentation clarity, specificity, ensure completeness of documentation required for code assignment within area(s) of assignment or specialty.
• Expanding skills in procedural coding such as CPT or PCS.

Claims Edit Coder

• Maximize reimbursement and minimize denials by ensuring proper coding guidelines are met

• You will be introduced to health insurance, multiple healthcare settings, coding, and reimbursement.
• You will become familiar with the health insurance industry, legal and regulatory issues, differences in reimbursement methodologies, and the principles of medical billing related to proper claim form preparation, submission and payment processing, and the follow-up process.
• Provide efficient and effective coding services on behalf of our member clients in accordance with Payer requirements and organizational policies, while ensuring compliance to all coding guidelines.
• Review and interpret patient encounters for accurate code assignment of all relevant diagnoses and procedures.
• Help fulfill the reimbursement needs of the member through review and recommendation or correct assignment of diagnosis and procedure codes which are critical to third party reimbursement.
• Research and obtain necessary information from provider/office via Epic in-basket when necessary, per agreement.
• Assist with research for denied claims.
• Meet assigned productivity goals.
• Establish and maintain positive working relationships with patients, payers, team members, clients and other stakeholders.
• Maintain confidentiality of patient information, organization data and information, and in compliance with HIPAA regulations.

Medical Billing and Coding Training Program

• Participants develop an understanding of how healthcare services are documented, coded, credentialed, enrolled with insurance payers, and reimbursed within healthcare organizations.
• Learners gain foundational knowledge of the three primary healthcare code sets used in medical billing and coding: CPT, ICD-10-CM, HCPCS Level II.
• Throughout the program, learners are introduced to the processes involved in provider credentialing and recredentialing, payer enrollment, and documentation verification.

Medical Billing and Coding – Training Program, Credentialing and Enrollment Internship

• Assigns either ICD-10-CM and PCS codes for inpatient visits or assigns ICD-10 CM codes, professional and technical EM levels, and surgical CPT codes for physician visits at commercially reasonable production rates and at a consistent 95% or greater quality level.
• Validates either MS-DRG or APC assignments, as applicable.
• Abstracts clinical data appropriately.
• Mitigates either hospital inpatient coding-related claims scrubber edits or professional and technical coding-related claims scrubber edits.
• Participates in client and Savista meetings and training sessions as instructed by management.
• Maintains an ongoing current working knowledge of the coding convention in play at client assignments.
• Performs other related duties as required.

Coder III

• reviews and educates providers when there is a dispute on adjudicated claims that contain a code editing related denial or financial recovery
• extracts clinical information from a variety of medical records and assigns appropriate procedural terminology and medical codes (e.g., ICD-10-CM, CPT) to patient records
• analyzes, enters and manipulates database
• responds to or clarifies internal requests for medical information
• prioritizes requests and interprets and adapts procedures, processes and techniques

Medical Coder

• Review clinical documentation to assign and sequence diagnostic and procedural codes for specific patient types to meet the requirements of hospital data or physician data retrieval for billing and reimbursement.
• Validate APC calculations to accurately capture the diagnoses/procedures documented in the clinical record for hospitals.
• Perform documentation review and assessment for accurate abstracting of clinical data to meet regulatory and compliance requirements.
• Interact with client staff and providers as needed.
• Select and sequence ICD-10, and/or CPT/HCPCS codes for designated patient types including but not limited to: Ancillary (Diagnostic)/ Recurring; Hospital, Clinic; Physician Pro Fee; Technical Fee or Evaluation and Management.
• Review and analyze facility records to ensure that APC assignments and/or Evaluation and Management codes accurately reflect the diagnoses/procedures documented in the clinical record.
• Complete assigned work functions utilizing appropriate resources.
• Maintain strict patient and provider confidentiality in compliance with all HIPAA Guidelines.
• Participate in client and Savista staff meetings, trainings, and conference calls as requested and/or required.
• Maintain current working knowledge of ICD-10 and/or CPT/HCPCS and coding guidelines, government regulations, protocols and third-party requirements regarding coding and/or billing.
• Participate in continuing education activities to enhance knowledge, skills, and maintain current credentials.

Profee Coder – Trauma

• 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

See all jobs on JobTailor

HIM Coding Specialist I

ED Professional Fee Coder

Risk Adjustment Coder

Medical Biller, Coder

Professional Surgical Coder II

Medical Billing Coordinator

Inpatient Coding Specialist

Medical Billing Specialist – Acute Care

Associate Coder

Medical Billing Specialist

Medical Billing Team Lead

Claims Edit Coder

Associate Coder

Medical Billing and Coding Training Program

Medical Billing and Coding – Training Program, Credentialing and Enrollment Internship

Coder III

Medical Coder

Profee Coder – Trauma

Certified Medical Coder

Certified Medical Coder – Temporary Contract