Medical Billing and Coding

• Codes and abstracts professional fee hospital services from medical records according to guidelines
• Utilizes 3M Encoder for validation of RVUs and procedure unbundling
• Maintains a 95% coding accuracy rate

Emergency Department Medical Coder – Per Diem

• 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

• Responsible for supervising the work of staff who review, interpret, code and abstract medical records information according to standard classification systems.
• Performs the most advanced medical records coding and abstraction duties.
• Performs data quality reviews and prepares complex reports as required.
• Promotes Coding Audit department goals by selecting, motivating, and training capable team members.
• Leads the activities of assigned Coding Audit team members by communicating and providing guidance toward achieving department objectives.
• Assists in analyzing common operational definition of metrics and assists in the development of regional reports to monitor individual hospitals in one database and develops processes to integrate clinical department managers in correction and resubmission of medical records.
• Assists with the development of tools to track performance including daily reports that track coding operations contribution to the DNFB, including progress toward the resolution of holds; applies data-driven methodologies to understand the current state of coding operations relating to individual hospitals.
• Compiles data into reports to identify trends and patterns in procedures; provides regional and local metric information for organization communications.
• Evaluates and implements systems, mechanisms, and procedures that ensure timely placement of documents in the patient medical record.
• Measures adherence of system(s) developed, handle delays and errors; ensures adherence to high-quality Medical Records standards.
• Assists the leadership in development of performance goals, dashboards and medical record chart assembly / delivery procedures; utilizes and reviews tools to track and monitor the prompt resolution of holds and non-coded accounts.
• Collaborates with site leadership to prioritize, schedule, assign, and monitor work to optimize operational services; maintains compliance with the policies, procedures and regulations of Medical Records; informs and educates staff of regulatory changes, as needed.
• Communicates case write-offs with senior leadership and Business Offices; supervises, hires, trains, disciplines, and evaluates the performance of staff; ensures performance appraisals are completed in a timely manner.
• Prioritizes, schedules, assigns and monitors work to optimize operational services; participates in developing and delivering training related to operations.
• Performs other related duties as assigned.

Medical Coding Supervisor

• Manages multiple EPIC work queues (WQs) to ensure timely billing and resolution of all encounters within 2–3 days.
• Monitors and audits coder performance, ensuring >/= 95% coding and DRG accuracy through regular reviews, meetings, and feedback sessions.
• Educates and mentors coding staff, providing onboarding for new coders, daily coaching, and monthly team meetings to maintain accuracy and compliance.
• Acts as a liaison between the Coding Division, CDI Program, physicians, and Revenue Integrity to improve documentation, query processes, and charge accuracy.
• Conducts daily coding audits and reviews all PSI, Vizient, and 3M data to validate coding accuracy, case quality, and performance metrics.
• Oversees the DRG validation and denial management program, resolving coding disputes and ensuring documentation supports accurate reimbursement.
• Applies national coding standards and metrics, maintaining expertise in SOI/ROM, AHRQ PSI criteria, NTAP cases, and Medicare reimbursement systems.
• Stays current on industry updates, including Medicare PPS changes, Coding Clinic guidance, and emerging trends such as SDOH and COVID-related coding.
• Drives process improvement initiatives, collaborating with CDI, Quality, and ER leaders to enhance documentation, reduce denials, and improve national quality ratings.
• Performs coding duties as needed, supporting workload balance, reducing discharged-not-billed (DNB) cases, and meeting monthly performance goals

Lead Coding Specialist

• Codes and abstracts diagnosis and procedure information from patient medical records according to AHA ICD-10-CM/PCS coding conventions, UHDDS and CMS guidelines and regulations
• Utilizes the 3M Encoder to verify and assign AHA ICD-10-CM/PCS codes, and MS-DRG/APR-DRG assignment
• Maintains 95% data quality coding accuracy rate as measured through quarterly department quality reviews
• Maintains daily productivity and turnaround times
• Responsible for remaining up-to-date with knowledge of AHA ICD-9-CM/ICD-10-CM/PCS coding conventions, MS-DRG and APR-DRG principles and guidelines
• Maintains a working knowledge of prospective payment systems as it relates directly to coding process
• Participation in department and sectional meetings, education sessional sessions and workshops as scheduled
• Maintains working knowledge of clinical documentation improvement program and functions as liaison for RN clinical documentation specialists
• Demonstrates/models the Network’s core values and customer service behaviors in interactions with all customers (internal and external)
• Maintains confidentiality of all materials handled within the Network/Entity as well as the proper release of information.

Inpatient Coding Specialist – Full Time

• 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

• 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

• Use various resources to support reviews; IE: CPT guidelines, CPT Assistant, Encoder Pro, 3M Software
• Review medical bills submitted by insurance companies related to MVA injuries sustained for NJ and or NY-covered insureds
• Interpret medical documentation ensure accuracy of billed services IE: CPT, HCPCs codes
• Assign proper CPT, HCPCs codes based on the review outcome
• Review CPT codes for unbundled services
• Review billed modifiers for accuracy of use
• Crosswalk CPT codes per regulatory requirements to ensure correct reimbursement
• Interpret fee schedule guidelines and apply those guidelines in daily reviews
• Document review outcomes for customers in a professional easy to understand manner
• Use various resources, IE: eBooks, 3M software to support reviews
• Participate in conference calls as needed with customers and/or attorneys
• Participate in virtual and in-person testimony or trial when needed
• Assist with various special projects and other duties as assigned

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