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

• 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

• Medical coding in an acute care setting; must possess proficient computer skills (e.g., MS Word, Excel, ICD 9 CM, CPT 4, Encoder);
• Knowledge of coding guidelines, payor guidelines, federal billing guidelines;
• Knowledge of anatomy, physiology & disease processes;
• Ability to research coding related issues;
• Competence in coder training;
• Must have CCS and knowledgeable with 3M/HDS coding application.
• Inpatient and ED experience.

Certified 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

• Medical Billing Associate handles billing and follow up of medical claims
• Focus on pre-billing edits and introductory payer denials
• Initiate appeals or rebill claims to address denials
• Work independently to meet production standards
• Communicate with peers, trainers, and leaders
• Resolve billing edits and respond to denials on accounts as assigned
• Collaborate with internal/external departments as needed
• Recognize payer trends and communicate them to leaders

Medical Billing Associate

• The HCC Certified Coder will be responsible for abstracting clinical information and assigning appropriate diagnosis and procedure codes in accordance with nationally recognized coding guidelines
• Analyze and translate medical and clinical documentation in alignment with the CMS Risk Adjustment Models
• Collaborate closely with the coding team and providers to ensure accurate and compliant documentation and coding practices
• Perform coding for patient health assessments
• Conduct peer coding quality reviews
• Support provider and coding team training and education
• Conduct prospective medical chart audits
• Perform coding abstraction and medical chart quality audits to ensure clinicians have accurate clinical documentation to support ICD-10 codes
• Educate clinicians on coding opportunities identified in chart reviews
• Perform accurate and timely coding (CPT, ICD-10, HCPCS, modifiers)
• Provide timely correspondence with providers regarding clinical documentation opportunities and queries
• Identify trends through data analysis or chart review
• Maintain a minimum of 95% coding accuracy and meet established productivity standards
• Stay current with regulatory, documentation, and coding guidelines

HCC Certified 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, 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

• Analyze outpatient medical records to extract clinical, pathological, therapeutic, and epidemiologic data
• Apply ICD-10-CM and CPT-4 coding principles to ensure accurate and compliant clinical data
• Verify patient demographics, admission details, discharge data, and treatment information prior to coding
• Assign and sequence principal and secondary diagnoses and procedures at the highest level of specificity
• Ensure coding accuracy to support research, reimbursement, planning, statistics, and regulatory reporting
• Enter and maintain accurate coding data across multiple databases and information systems
• Complete assigned case volumes, corrections, and special coding projects within established standards

Medical Coding Specialist I – Outpatient

• Provides leadership and subject matter expertise to the coding team across inpatient and/or outpatient care settings.
• Ensures daily operational functions are met, supports coding quality and compliance.
• Serves as a super user and resource for internal and external stakeholders.
• Monitors daily activity of coding work queues to support productivity benchmarks and turnaround times.
• Collaborates with various stakeholders to identify and resolve coding-related issues impacting reimbursement or compliance.
• Maintains regular hands-on coding responsibilities.

Lead Coder

• Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and ICD-10-PCS codes for billing, internal and external reporting, research, and regulatory compliance.
• Demonstrate knowledge of reimbursement methodologies and apply these to assigned charts to optimize reimbursement and/or resolve regulatory edits.
• Resolve error reports associated with billing process, identify and report error patterns, and, when necessary, assist in design and implementation of workflow changes to reduce billing errors.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA), adheres to official coding guidelines, and keeps abreast of coding changes and interpretation of codes.
• Complies with RRH & HIM department policies & procedures
• Perform detailed review of Inpatient record documentation to identify & assign diagnosis & procedure codes using ICD-10-CM and ICD-10-PCS.
• Meets established departmental productivity guidelines with 95% accuracy on a consistent basis.
• Utilizes Care Connect, UDS and Clintegrity systems proficiently to obtain ICD10 codes and DRG assignment.
• Formulates compliant Physician Coding Queries when documentation is inadequate, ambiguous or unclear for coding purposes
• Enters and/or updates data accurately including Present on Admission (POA) indicators, Point of Origin, Discharge Disposition and other identified data.
• Manages problematic workflow edits and other technical issues to ensure timely resolution specific to coding A/R days
• Corrects failed claim errors to billing edits, accounts misclassified and/or other errors identified through various auditing processes in a timely manner.
• Attends RGHS, HIM Department and Coding Team meetings and training sessions as required.
• Ensure timely reporting for external regulations
• Completes other duties as assigned by HIM leadership.
• Provide assistance to customers (physicians, clinical quality staff) regarding clinical documentation opportunities, coding reimbursement issues, and quality improvement review process.

Coder – Inpatient

• Own high-impact medical billing and insurance cases end-to-end
• Assess whether procedure, diagnosis, and modifier codes on an EOB are consistent with service described
• Identify coding conflicts and escalate or dispute them with the appropriate party
• Advocate for users by pushing cases forward with persistence
• Communicate clearly with users, setting expectations and sharing progress

Healthcare Advocate, Medical 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 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

• 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

• Provides leadership and subject matter expertise to the coding team
• Ensures daily operational functions are met
• Supports coding quality and compliance
• Assists with complex coding questions and workflow improvements
• Balances hands-on coding responsibilities with mentoring and auditing
• Collaborates with various departments to resolve coding-related issues
• Provides education and guidance related to documentation and coding best practices

• 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

• Resolve the more intricate billing edits as assigned.
• Follow up on the No Response WQs as assigned.
• Communicate with the payer via phone, email, or website platforms as needed.
• Respond to denials received on accounts as assigned.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
• Identify and present the payer trends amongst the claims that are editing for similar reasons.
• Proper and detailed notation of actions taken on the account.
• Review, understand, and locate payer policy guidelines as required.
• Ability to work independently and under time constraints and deadlines and with minimal supervision.
• Meet daily/weekly productivity standards with acceptable QA results.

Medical Billing Analyst

• Resolve the more intricate billing edits as assigned.
• Follow up on the No Response WQs as assigned.
• Communicate with the payer via phone, email, or website platforms as needed.
• Respond to denials received on accounts as assigned.
• Collaborate professionally internally or with external departments when needed to resolve the edit or denial.
• Identify and present the payer trends amongst the claims that are editing for similar reasons.
• Proper and detailed notation of actions taken on the account.
• Review, understand, and locate payer policy guidelines as required.

See all jobs on JobTailor

Medical Coder

Risk Adjustment Coder

Certified Medical Coder

Coder II – Cardiology

Medical Billing Associate

HCC Certified Coder

Coder II – ENT, Audiology

Medical Coding Specialist I – Outpatient

Lead Coder

Coder – Inpatient

Healthcare Advocate, Medical Coding

Inpatient Coder

Physician Support Coder

Facility ED Coder

Lead Coder

Complex Coder, Surgical Cardiology

Medical Billing Analyst

Medical Billing Analyst