Medical Billing and Coding

• 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

• Analyzes relevant clinical and demographic information from the Health Information record
• Assigns appropriate ICD-10 codes following appropriate guidelines
• Completes analysis of documentation, abstracting and code assignment by body system, organ, etiology and morphology according to the American Hospital Association Official ICD-10 Coding Guidelines
• Performs queries and obtains documentation required for coding
• Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations
• Answers customer calls
• Demonstrates basic knowledge of revenue cycle

Certified Coding Specialist

• 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

• 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

• Analyzes relevant clinical and demographic information from the Health Information record
• Assigns appropriate ICD-10 and CPT codes following appropriate guidelines
• Ascertains compliance with CMS, state and other regulatory agencies
• Provides mentorship and training to onboarding coders
• Completes analysis of documentation and code assignment according to the American Hospital Association Official ICD-10 Coding Guidelines
• Performs queries and obtains documentation required for coding
• Maintains communication with Management and Providers to ensure timely notification of identified documentation issues

Senior Certified Coding Specialist – Surgical Coding

• 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

• Codes ER's, outpatients, outpatients surgeries, observations and inpatients.
• Works CCI/medical necessity edits as needed.
• Monitors unbilled for all patient types coded on a day-to-day basis.
• Maintains quality equal to or greater than 95%.
• Maintains productivity equal to or greater than 95%.
• Completes continuing education as required.

Coder Specialist III

• Analyzes relevant clinical and demographic information from the Health Information record.
• Assigns appropriate ICD-10 codes following guidelines.
• Ensures compliance with CMS, state, and other regulatory agencies.
• Completes analysis of documentation, abstracting, and code assignment.
• Performs queries and obtains documentation required for coding.
• Maintains current knowledge of coding guidelines and relevant federal regulations.
• Answers customer calls.
• Demonstrates basic knowledge of the revenue cycle.

Certified Coding Specialist – Professional Cardiology Coding

• Analyzes relevant clinical and demographic information from the Health Information record
• Assigns appropriate ICD-10 and CPT codes following appropriate guidelines
• Ensures compliance with CMS, state and other regulatory agencies
• Provides mentorship and training to on-boarding coders
• Completes analysis of documentation, abstracting and code assignment by body system, organ, etiology and morphology
• Performs queries and obtains documentation required for coding for records maintained in other departments
• Coordinates documentation needs, query follow-up and final DRG assignment with the Clinical Documentation Specialist
• Reviews provider documentation for coding appropriateness
• Analyzes medical records to complete accurate code selection
• Assigns diagnosis and procedure codes for clinic visits, surgical procedures/deliveries, and other billable professional services
• Acts as a mentor to other team members

Certified Coding Specialist Sr – Surgical Coding

• 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 claims directly from the medical record/operative report according to coding guidelines
• Accurate and timely completion of work queues as assigned
• Track and identify trends within charge review and follow up work queues and assist leadership in the resolution of those trends and/or educational needs
• Assists with research of denied claims
• Maintains compliance with established corporate and departmental policies and procedures, quality improvement program, customer service and productivity expectations
• Must be able to achieve individual quality and productivity performance metrics in daily duties as set by coding leadership
• Provide and/or assist with provider education, as well as the development of educational tools
• Communicates professionally with physicians, management, and peers
• Participates in all educational activities including coding meetings/calls necessary to provide information relating to coding and compliance
• Remains abreast of changes to current payer guidelines, Correct Coding Initiative edits, and Local/National Coverage Determinations for accuracy in Coding and mentors team members regarding coding guidelines and accuracy
• Assists with training of other coders
• Takes initiative for learning new skills and willingness to participate and share expertise on projects, committees and other activities as deemed appropriate
• Demonstrates personal responsibility for job performance
• Extensive knowledge/experience in physician coding with expert knowledge in a specific coding specialty and the ability to provide education/support to coding team and providers. Possible travel for education sessions, CME events, etc. as defined by Physician Revenue Cycle Leadership.

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