Medical Billing and Coding

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records while ensuring accuracy for billing, reimbursement, and compliance
• Review medical records for DRG/APC assignment, verify charge accuracy, abstract clinical data, and collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance
• Accurately reflects the diagnosis and procedures per department procedure within the medical records
• Proactively communicates with providers, staff, leadership and hospital departments to ensure adequate documentation to support services
• Performs Charge capture and data entry per department protocol and procedure
• Ensures accurate abstracting of clinical data and meets regulatory and compliance requirements

Certified Facility Coder

• Utilize technical coding expertise to assign appropriate ICD-10-CM and CPT-4 codes to outpatient visit types.
• Review the medical record thoroughly, utilizing all available documentation to code appropriate diagnoses and procedures.
• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease process, pharmacology, and medical terminology to report appropriate diagnoses and/or procedures.
• Send appropriate physician queries when required for documentation clarification.
• Follow Coding Clinic for HCPCs, CPT Assistant, and interpret coding conventions and instructional notes to select appropriate diagnoses and procedures with a minimum of 95% accuracy.

Outpatient Coder II, HB Coding

• Ability to comprehend medical record documentation to accurately assign codes for both concurrent and discharged accounts across multiple specialties.
• Meets minimum requirements for production and quality monthly.
• Requires a working knowledge of code sequencing for grouper-related payers with attention to detail to avoid rework and waste with charge capture assessment component.
• Requires understanding and application of M.E.A.T. criteria (i.e., monitoring, evaluation, assessment, treatment) using ICD 10 CM transaction data set to capture diagnoses.
• Analyzes high-risk encounters for accurate and/or missing charges gaps prior to encounter completion (i.e., missing charges from anesthesia, surgery) when manual charge capture occurs.
• Understand complexity of billing requirements and incorporates payer specific trends into day-to-day reviews to reduce “take backs” associated with unclear, or unsubstantiated care rendered. (i.e., varying modifier assignment for EAPG vs. Non-EAPG payer specificity)
• Requires excellent coding knowledge of ICD 10 CM, CPT 4, and modifier application, with expectations to maintain certification (i.e., CCS, CPC, RHIT, or RHIA) and apply ICD 10 CM Coding Guidelines specific to both inpatient and outpatient encounters.
• Facilitate modifications to clinical documentation through query interaction to ensure that the information captured supports the level of service rendered, with attention towards chronic conditions, hierarchical condition categories (HCC), and risk adjustment factors (RAF).
• Demonstrates an excellent working knowledge of hospital information systems to retrieve data specific information (i.e., order diagnosis, patient type) within a complicated filing schema including non-hospital data (i.e., Media Tab, Office Visits etc)

Outpatient Surgery Coder

• Abstracts and codes physician professional services and diagnosis codes (inpatient admissions, outpatient procedures, diagnostic services)
• Assigns appropriate CPT and ICD9 codes
• Completes coding and billing worksheet
• Ensures charges are captured by performing various reconciliations (procedure schedules, clinical system reports, fatal edit reports)
• Provides documentation feedback to physicians
• Maintains coding reference information
• Trains physicians and other staff regarding documentation, billing and coding
• Reviews and communicates new or revised billing and coding guidelines and information
• Resolves pre-accounts receivable edits and monitors reasons for missed billing opportunities

Coding Specialist

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• Responsible for coding and abstracting inpatient accounts in accordance with coding guidelines.
• Assigns accurate diagnostic and procedure codes according to clinical documentation and official coding guidelines for inpatient hospital accounts.
• Coordinates with the clinical documentation and quality teams to ensure validation of Medicare Severity Diagnosis Related Group (MSDRG), patient safety indicators, and hospital acquired conditions are supported by physician documentation to support appropriate coding.
• Monitors assigned work queues to ensure all records are charged in a timely matter.
• Generates coding queries for clarification regarding physician documentation as needed.
• Stays abreast of all changes in coding conventions and coding updates.
• Performs other duties as assigned.

Coder – Hospital Inpatient

• Accurately assigns appropriate ICD-10-CM and CPT-4 codes to outpatient records
• Abstract essential data elements for tracking, reporting, and reimbursement purposes
• Keying, billing and collections for assigned client databases
• Review and analyze medical records for document deficiencies
• Ensure accurate coding and compliance with Federal and State regulations
• Verify accuracy of patient account, type, and demographic data
• Meet productivity standards set by Revenue Integrity Coding department

Certified Professional Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Responsible for timely and accurate coding and abstracting of Inpatient visits
• Codes and abstract patients following established coding guidelines and utilizing ICD-10 code sets
• This position ensures that revenue cycle, customer service, quality, individual, and team goals are met
• Thorough review of inpatient encounter documentation for diagnoses, treatments, services
• Performs daily coding and abstracting utilizing ICD-10 Code sets and DRG Grouping systems
• Validates MS-DRG and APR-DRG assignment for appropriateness to encounter
• Performs weekly coding of Inpatient Interim Bill Requests
• Review of Clinical Documentation Specialists notes and queries to ensure capture of queried conditions
• Validates admission diagnosis assignment and coordinates correction with Case Management personnel when appropriate
• Identifies documentation issues that may lead to incorrect coding, billing, and quality metrics
• Communicates issues to Clinical Documentation Specialists for clarification and/or resolution when appropriate
• Facilitates accurate Hospital Acquired Conditions reporting with Infection Control and/or coordinates retrospective query with CDI team as appropriate
• Performs research and/or seeks assistance from Nosology, CHA and American Hospital Association on complex coding cases
• Documents findings and educates team on coding guidance
• Makes recommendations on Epic coding and SVC edits to prevent coding, billing, IHA and claim edits
• Maintains quality standards of AHA, AMA, CMS, OIG and TJC pertaining to coding and reimbursement
• Stay current in Coding changes by reading, maintaining CEUs, and attending education sessions related to Coding and Health Information Management
• Trains and orients new employees
• Assists with testing and implementation of systems/product changes and upgrades
• Performs other duties as assigned by the coding manager or the director

HIM Coder III

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Responsible for accurate and timely coding of hospital inpatient, outpatient and/or professional fee encounters using ICD10/ICDPCS, CPT, or HCPCs codes
• Responsible for understanding and applying all regulatory coding guidelines
• Develops methodology for a coding process compliant with regulatory agencies
• Facilitates optimization of revenue while maintaining compliance standards
• Serves as an expert resource regarding various coding systems and regulatory guidelines
• Reports documentation and coding improvement needs based on review findings
• Performs provider and peer coding audits as requested
• Monitors internal controls for coding and billing

HIM Cert Coder, IP

• 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

• Responsible for oversight of teams performing revenue cycle functions across multiple clients
• Support domestic business office staff as a point of contact for day-to-day management
• Own client facing meetings, including agendas and reports
• Manage team metrics and individual productivity
• Collaborate with Shared Services for client onboarding
• Review and approve employee time including overtime
• Create and maintain unit budget and KPIs

Medical Coding Supervisor – Epic Professional Billing

• 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 and Coding jobs in Illinois

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