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

• 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

• 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

• 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

• 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

• Learn, understand, and follow established workflow processes for each client.
• Create accurate and clean claims in a timely manner.
• Follow up and track claims to ensure proper payment.
• Append modifiers, reassign diagnosis pointers, and understand basic medical billing coding guidelines.
• Write and send persuasive appeal letters when necessary.
• Utilize insurance portals to track and appeal claims, confirm eligibility, communicate with insurance representatives, and locate reimbursement policies.
• Strive to meet and exceed MGMA AR Benchmark Standards.
• Log in to the assigned Team Phone Queue daily to assist patients with billing-related questions.
• Be flexible and willing to take on additional tasks as needed.

Cardiology Medical Billing Specialist

• Responsible for appealing claims denied by third-party payers
• Creates appropriate letters and compiles documentation to substantiate the validity of claims
• Investigates and problem solves reimbursement issues in collaboration with other coding staff and faculty
• Works directly with physicians and other clinical staff as needed to provide documentation feedback and to develop appeals
• Researches payer policies and processes
• Reviews clinical documentation in the medical record to identify all pertinent facts necessary to select the comprehensive diagnoses and procedures that fully describe the patient's conditions and treatment
• Codes evaluation and management services to the appropriate CPT code level
• Ensures ICD codes are linked appropriately to services provided
• Responsible for charge corrections when necessary
• Works assigned Epic Work queues, CRM tasks, and reviews remittance advice for rejections and accuracy of payment amounts as needed
• Identifies invoices that have been rejected per department criteria
• Performs accounts receivable (AR) functions in the Epic billing system, including updating insurance information, demographics
• Completes special projects as assigned

Certified Coder – Physicians Billing Service

• Assigns ICD-10-CM, CPT, and HCPCS Level II codes to completed and signed medical documentation creating an appropriate assigned medical claim.
• Abstracts specified data and information from patient records in order to determine appropriate modifiers for claim submission.
• Queries providers for clarification of documentation when unclear or inadequate in order to code accurately.
• Requests providers to complete addendums as necessary.
• Stays up-to-date with ICD-10-CM, CPT, HCPCS Level II, AMA, CMS and other federal, state, local, and Phelps Health-specific coding guidelines, rules, and regulations and applies those guidelines to all types of patient accounts.
• Abides by AAPC’s “Standards of Ethical Coding” and Phelps Health’s Corporate Compliance coding guidelines.
• Monitors providers documentation for timely completion.
• Notifies Coding Manager of any providers who fall outside the designated 73-hour turnaround time frame.
• Maintains the designated 3 business day time frame for coding completed records and provides weekly report summaries to Coding Manager.
• Maintain productivity standards as set forth by Phelps Health productivity matrix.
• Maintain annual certification through AAPC or AHIMA and completes required CEUs for certification maintenance.

Coder – IPT

• 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

• 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

• 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

Complex Coder, Surgical Cardiology

• 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.

Coding Specialist I

• Ensure coding for telehealth consultations is appropriate
• Review and analyze documentation in medical records for inpatient and outpatient visits
• Determine appropriate charge and modifier assignments as described by physicians of record
• Abide by Standards of Ethical Coding set forth by the American Health Information Management Association
• Adhere to official coding guidelines
• Maintain expert knowledge of telehealth regulations across multiple states
• Perform duties consistent with Mercy's mission, values, and service standards

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Medical Coder

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Coding Specialist II, PB Coding

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Coder

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Cardiology Medical Billing Specialist

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Medical Coder

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