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

• 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

• Code all inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services
• Ensure adherence to Hospital and Departmental Policies and Procedures
• Demonstrate knowledge of coding multiple areas of service and/or specialties or extensive experience in a specific specialty
• Review patients' entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG
• Access several systems via the computer to research the medical record to code in a timely manner
• Take responsibility for accounts receivable by looking for lost documents
• Maintain and disseminate up-to-date technical knowledge of legal and regulatory information concerning the given business area
• Responsible for resolving any and all pre-bill edits, denials, etc. for assigned accounts

IP Facility Coder

• Code all of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services
• Ensure adherence to Hospital and Departmental Policies and Procedures
• Review patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG
• Access several systems via the computer to research the medical record when needed
• Take responsibility for accounts receivable by looking for lost documents
• Maintain and disseminate up-to-date technical knowledge of legal and regulatory information
• Responsible for resolving any and all pre-bill edits, denials, etc.
• Participate in all departmental in-services and updates

IP Facility PCS, ICD-10 Coder

• Codes more than one of the following: inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers
• Ensures adherence to Hospital and Departmental Policies and Procedures
• Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG (as defined by UHDDS guidelines and CMS)
• Abstracts data essential to the QI department in determining patient care issues as well as providing information to The Joint Commission
• Accesses several systems via the computer to research the medical record when needed to complete the coding in a timely manner
• Takes responsibility for accounts receivable by looking for lost documents to insure all encounters are coded, including the generation of appropriate queries, as needed
• Responsible for resolving any and all pre-bill edits, denials, etc for assigned accounts
• Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area
• Participates in all departmental in-services and updates to stay current with the accepted coding guidelines and improve personal knowledge of medicine and treatment
• Communicates issues to the EW Clinical Coding Manager & Supervisor, as appropriate
• Must demonstrate knowledge of coding multiple areas of service and/or specialties
• Maintains at least a 95% accuracy rate
• Maintains average to high productivity based on PHS Productivity Standards
• Maintains continuing education (CE) requirements per PHS policy

PRN EKG Coder

• Reviews patients entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG to be used for financial reimbursement, research in accordance with Federal Regulations and Hospital and Departmental policies
• Abstracts data essential to the QI department in determining patient care issues as well as providing information to The Joint Commission
• Accesses several systems via the computer to research the medical record when needed to complete the coding in a timely manner
• Takes responsibility for accounts receivable by looking for lost documents to insure all encounters are coded, including the generation of appropriate queries
• Responsible for resolving any and all pre-bill edits, denials, etc for assigned accounts
• Maintains and disseminates up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area
• Participates in all departmental in-services and updates to stay current with the accepted coding guidelines and improve personal knowledge of medicine and treatment
• Must demonstrate knowledge of coding multiple areas of service and/or specialties
• Maintains at least a 95% accuracy rate
• Maintains average to high productivity based on PHS Productivity Standards
• Maintains continuing education (CE) requirements per PHS policy

IP Facility CCS Coder

• Codes inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records, and/or professional fee services for PMG specialty providers for reimbursement, research and compliance with Federal regulation.
• Reviews patients' entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG.
• Abstracts data essential to the QI department in determining patient care issues.
• Accesses systems via computer to research the medical record for timely coding.
• Takes responsibility for accounts receivable by looking for lost documents.
• Resolves any pre-bill edits, denials for assigned accounts.
• Maintains and disseminates up-to-date technical knowledge of coding updates.

PRN HCC Coder, CRC

• 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

• code inpatient and/or outpatient hospital records
• code ED records
• code Home Health & Hospice records
• code professional fee services for PMG specialty providers
• demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership
• ensure adherence to Hospital and Departmental Policies and Procedures
• review patients entire current medical record
• assign appropriate codes including CPT, ICD and MS-DRG
• access several systems via the computer
• maintain and disseminate up-to-date technical knowledge of legal and regulatory information
• resolve any and all pre-bill edits, denials, etc. for assigned accounts
• participate in all departmental in-services and updates

Certified Cardiothoracic Vascular Surgery Coder

• 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

Certified Medical Coder – Temporary Contract

• Oversees the daily operations of a medical coding team, ensuring compliance with Federal, State, and third-party billing regulations.
• Assists in the planning, organizing, staffing, and daily operations of the coding area to ensure timely completion of medical record coding reviews, revenue cycle initiatives, and serves as a subject matter expert on documentation and coding requirements to ensure optimal reimbursement and compliance with regulatory compliance.
• Develops and analyzes reports to monitor and enhance coding accuracy, operational efficiency, and equitable workload distribution.
• Identifies, recommends, and implements opportunities for operational improvements within medical coding processes.
• This position serves as a collaborative resource to other departments, providers, leadership and revenue cycle staff on organizational projects and initiatives.

Medical Coding Supervisor

• Code inpatient and/or outpatient hospital records
• Review patients' entire current medical records
• Assign appropriate codes including CPT, ICD and MS-DRG
• Access several systems to complete coding in a timely manner
• Maintain and disseminate up-to-date technical knowledge of legal and regulatory information
• Resolve any and all pre-bill edits, denials, etc. for assigned accounts

IP Facility Coder III – CCS

• 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

• code inpatient and/or outpatient hospital records, ED records, Home Health & Hospice records and/or professional fee services for PMG specialty providers
• demonstrate coding expertise in a specific specialty deemed a critical business need by PHS Coding Leadership
• ensure adherence to Hospital and Departmental Policies and Procedures
• review the patient's entire current medical record, assigning appropriate codes including CPT, ICD and MS-DRG
• access several systems via the computer to research the medical record when needed to complete the coding in a timely manner
• take responsibility for accounts receivable by looking for lost documents to ensure all encounters are coded
• maintain and disseminate up-to-date technical knowledge of legal and regulatory information from all appropriate jurisdictions concerning the given business area
• responsible for resolving any and all pre-bill edits, denials for assigned accounts
• participate in all departmental in-services and updates to stay current with accepted coding guidelines

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