Medical Billing and Coding

• 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 & Collections Specialist

• Responsible for assigning appropriate diagnostic and procedural codes to patient charts of moderate to high complexity using ICD-10-CM, ICD-10-PCS, CPT, HCPCS or any other designated coding classification system in accordance with coding rules and regulations.
• Abides by the Standards of Ethical Coding as set forth by AHIMA.
• The Outpatient Coder shall review hospital outpatient medical documentation or physician medical record documentation to assign, sequence, edit and/or validate the appropriate ICD-10-CM, CPT and HCPCS codes with outpatient encounters to ensure proper coding, billing and compliance.
• Will match outpatient coding area to experience (i.e. Same Day Surgery, Routine Outpatient, Physician, Recurring, Observation, etc.).
• Reviews encounter to assign and sequence appropriate diagnoses and/or procedure codes as well as modifiers to diagnostic, physician and/or surgical encounters in accordance with Official Coding Guidelines, CMS regulations, Local Medical Review Policy (LMRP), guidance in encoder software and HIM coding policies and procedures.
• Using 3M encoder, reviews Ambulatory Payment Classifications (APC) and coding edits.
• Reviews Local/National Coverage Determination (LCD/NCD) edits and guidance for codes meeting medical necessity.
• Research electronic medical record for any additional diagnoses documented to meet medical necessity.

Outpatient Acute Care Coder – Emergency

• Utilizes technical coding expertise to reviews the medical record thoroughly, utilizing all available documentation abstract and code physician professional services and diagnosis codes (including anesthesia encounters, operative room and surgical procedural services, invasive procedures and/or drug infusion encounters).
• Follows Official Guidelines and rules in order to assign appropriate CPT, ICD10 codes and modifiers with a minimum of 95% accuracy.
• Ensures charges are captured by performing various reconciliations (procedure schedules, OR logs and clinical system 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.
• Attends meetings and educational roundtables, communicates pertinent information to physicians and staff.
• Resolves pre-accounts receivable edits. Identifies repetitive documentation problems as well as system issues.
• Makes appropriate changes to incorrectly billed services, adds missing unbilled services, provides missing data as appropriate, corrects CPT and ICD9 codes and modifiers. Adds MBO tracking codes as needed.
• Collaborate with Patient Accounting, PB Billing, and other operational areas to provide coding reimbursement expertise; helps identify and resolve incorrect claim issues and is responsible for drafting letters in order to coordinate appeals.
• Acts as key point person for Revenue Cycle staff and Account Inquiry Unit staff in obtaining documentation (notes, operative reports, drug treatment plans, etc.). Provides additional code and modifier information to assist with appealing denials. May contact providers for peer-to-peer reviews.
• Meets established minimum coding productivity and quality standards for each encounter type.
• May perform other duties as assigned.

Coding Specialist II, PB Coding

• Come join us as a Coder I, Professional at SSM Health!
• Play a crucial role in ensuring accurate and timely coding of medical records.
• Responsible for reviewing patient information, assigning appropriate codes, and ensuring compliance with coding guidelines and regulations.
• Manages assigned charge review and coding-related claim edit work queues to ensure timely and accurate charge capture.
• Accurately deciphers charge error reasons and plans follow-up steps.
• Identifies all billable services.
• Reviews all applicable data sources, including but not limited to electronic health records, inpatient admits, discharge and transfer (ADT) reports, operative logs, nursing home visit documentation, procedure reports generated from non-electronic health record systems, etc.
• Identifies need for medical records from outside the organization and follows established procedures to obtain.
• Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Consults with physicians/providers as needed to clarify any documentation in the record that is inadequate, ambiguous, or unclear for coding purposes.
• Provides education around documentation improvement for maximum patient care.
• Assists physicians/providers with questions regarding coding and documentation guidelines.
• Provides ongoing feedback based on observations from coding physician/provider documentation.
• Identifies opportunities for education and communicates trends to leaders.
• Reviews and resolves charge sessions that fail charge review edits and claim edits.

Coder I

• Reviews, analyzes, and interprets provider documentation with regards to procedure and diagnosis code selection
• Performs audits of provider coding and documentation to make recommendations for improvements and enhancements
• Maintains a close working relationship with assigned providers and medical office, frequently querying the provider when coding discrepancies arise
• Researches any coding inquiries the provider or medical staff may have, and presents findings to them
• Reviews hospital, clinical, and surgical documentation and the assigned diagnosis and procedure codes, releasing charges within the Epic system
• Identifies discrepancies between the provider code selection and the medical record documentation; makes appropriate corrections, and presents findings and education to the provider
• Demonstrates extensive knowledge of official coding guidelines established by the American Medical Association (AMA), the Center for Medicare & Medicaid Services (CMS) and contracted payers
• Works with billing partners in developing efficient coding processes and researching denials
• Responds to customer concerns through coding reviews requested by other departments
• Conducts provider coding orientation and education sessions and documents all information presented
• Maintains an in-depth knowledge of Epic ambulatory and hospital modules
• Works as a team to achieve productivity goals

Medical Coding 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

• 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 un-clear, or un-substantiated care rendered.
• 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).

Inpatient Coder

• 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

• 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

• 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 un-clear, or un-substantiated 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)

Facility ED Coder

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel.
• Identify, report, and resolve coding and reimbursement issues.

Coding Specialist II – Radiation Oncology

• Perform coding and related duties using established billing office policies in an accurate and timely manner.
• Primary contact with physicians, department administrators, hospital and/or clinical department administrators and their support staff and billing staff.
• Coordinates professional service billings for selected clinical departments.
• Assignment or verification of CPT, ICD-10 CM coding and modifiers based upon documentation.
• Resolve edits for electronic charges, following established policies and procedures to ensure that all data elements (claim requirements – CPT, ICD-10 CM, modifiers, provider, billing area, etc.) are applied.
• Monitor charge flow and act as a liaison with managers, department administrators and other billing personnel to assure consistent and accurate change flow.
• Identify, report, and resolve coding and reimbursement issues.
• Develop and maintain all protocols related to their assigned areas.
• Maintain understanding all Teaching Physician and provider documentation policies.
• Actively participate in new provider orientations.

Coding Specialist II – Psychiatry

• Abstracts and codes physician professional services and diagnosis codes
• Assigns appropriate CPT and ICD9 codes
• Completes coding and billing worksheet
• Ensures charges are captured by performing various reconciliations
• 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

Coding Specialist, Bronchoscopy

• Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
• Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
• Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards.
• Share results of quality reviews to HIM Leadership with recommendations for education and training.
• Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews.
• Identify coder training needs, system issues, and/or documentation issues and report them timely to HIM leadership.
• Review and respond to coding denials and coding questions as requested or assigned and perform clinical validation of appeal letters as needed.
• Participate in system and new application testing as needed.
• Provide denial trending data to leadership as requested.
• Develop and perform HIM coding team member group education on coding topics identified during quality reviews and denial reviews.

HIM Cert Coder, Quality Review Analyst

• Performs Current Procedural Terminology (CPT) and International Classification of Diseases coding through abstraction of the medical record.
• Trains physicians and other staff regarding documentation, billing and coding.
• Performs various administrative and clerical duties to support the role’s core function.
• Ensures charges are captured by performing various reconciliations.

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