Medical Billing and Coding

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to ensure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex (problematic coding that needs research and reference checking) medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs in areas of specialization.
• Sequence the diagnoses and procedures using coding guidelines.
• Ensure DRG/APC assignment is accurate.
• Abstract and compile data from medical records for appropriate optimal reimbursement for hospital and/or professional charges.
• Consult with and educate physicians on coding practices and conventions in order to provide detailed coding information.
• Communicate with nursing and ancillary services personnel for needed documentation for accurate coding.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs to effectively apply ICD-10-CM and CPT-4 coding guidelines to inpatient and outpatient diagnoses and procedures.
• Maintain a thorough understanding of medical record practices, standards, regulations, Joint Commission on Accreditation of Health Organizations (JCAHO), Health Care/Finance Administration (HCFA), Medical Review of North Carolina (MRNC), etc.
• Assist with special projects as required.
• Perform other related duties incidental to the work described herein.

Medical Records Coder II – Ophthalmology

• Assigns ICD-10-CM codes, and CPT/HCPCS codes for emergency department medical record accounts
• Abstracts key data elements required for billing
• Reviews records for clinical pertinence and documentation
• Communicates with providers for clarification of documentation
• Reviews and resolves claim edits related to emergency department encounters
• Assists with resolution of simple visit coding errors
• Demonstrates courtesy and professionalism through interaction
• Maintains patient confidentiality
• Acknowledges and supports Hospitals defined goals

Coder, ED

• Supports assigned inpatient and/or outpatient coding operations through day-to-day workflow leadership.
• Provides oversight of coding quality, coding edits, auditing, and staff education.
• Monitors coder productivity and quality and provides timely feedback.
• Ensures encounters processed by the coding team include an appropriate documented claim-hold reason before final billing.
• Develops, implements, and monitors coding policies and procedures that support accurate coding and compliance.
• Tracks and trends post-discharge coding queries and provides education.

Senior Outpatient Coder

• Evaluates medical records, provides clinical and surgical abstraction and assigns appropriate clinical diagnosis and procedure codes.
• Analyzes medical information from medical records
• Accurately codes diagnostic and procedural information in accordance with national coding guidelines
• Consults with medical providers to clarify missing or inadequate record information and to determine appropriate codes.
• Provides thorough, timely and accurate coding in accordance to department specific productivity and quality standards.

Profee Coder – Primary Care

• Ensure 100% charge capture by reviewing physician dictated notes and operative reports and properly code all services performed utilizing appropriate CPT, ICD-10-CM codes and modifiers.
• Daily review of EPIC Charge Review Work queues is essential.
• Monitor and report on accounts receivable issues related to payer compliance and/or billing processes.
• Act as a resource to providers, office staff, administration and the Central Business Office.
• Participation in coding training and education is also required.
• Maintain yearly certification as a Certified Professional Coder is required with the American Academy of Professional Coders.

Senior Billing Liaison, Coder

• Reviews the documentation in the record to identify all pertinent facts for appealing the claims denied by third-party payers or holds in host systems or billing clearinghouse
• Creates appropriate letters to substantiate the validity of claims
• Meets with facility liaison to review documentation, resolve coding, and tagging files for follow-up
• Investigates and problem-solves reimbursement issues in collaboration with other coding staff and faculty
• Works directly with facility liaison or 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
• Works assigned work queues and tasks and reviews remittance advice for rejections and accuracy of payment amounts as needed
• Identifies invoices or claims that have been rejected per billing edits/criteria

Coder, Edit/Denials

• Assign and sequence ICD-10-CM, ICD-10-PCS, and CPT-4 codes for inpatient, outpatient, ambulatory, and emergency room records while ensuring accuracy for billing, reimbursement, and compliance
• Review medical records for DRG/APC assignment, verify charge accuracy, abstract clinical data, and collaborate with providers and hospital departments to ensure proper documentation and regulatory compliance
• Accurately reflects the diagnosis and procedures per department procedure within the medical records
• Proactively communicates with providers, staff, leadership and hospital departments to ensure adequate documentation to support services
• Performs Charge capture and data entry per department protocol and procedure
• Ensures accurate abstracting of clinical data and meets regulatory and compliance requirements

Certified Facility 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 unclear, or unsubstantiated 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)

Outpatient Surgery Coder

• Reviewing documentation and selecting the appropriate procedure and/or diagnosis code to be entered in billing documents
• Ensuring that teaching physician requirements are met and clearly reflected in the documentation
• Other duties as assigned

Certified Coder – Practice Operations, Certified Professional Coder certification required

• Reviewing documentation and selecting the appropriate procedure and/or diagnosis code for billing documents
• Ensuring teaching physician requirements are met and clearly reflected in the documentation
• Other duties as assigned

Certified Coder – Part-Time

• Prepare, review, and submit clean medical claims to commercial payers.
• Verify claim accuracy, including coding, modifiers, eligibility, EAP authorizations, and provider details
• Monitor claim rejections and take timely corrective actions
• Manage denial resolution: research root cause, correct and resubmit, or prepare appeals
• Conduct proactive follow-up on outstanding A/R and aging claims
• Support patient billing activities and inquiries when needed
• Document all billing activities clearly and accurately in internal systems
• Ensure compliance with HIPAA, payer regulations, and state/federal billing guidelines
• Collaborate with credentialing, eligibility/benefits, clinical operations, and internal RCM teammates
• Identify trends and recommend process improvements to reduce denials and rework

Medical Billing Specialist

• Execute tasks focused on revenue generation through account resolution for any company client.
• Review documentation to support or contest payer coding decisions for multiple facilities.
• Prepare clear, concise, and well-supported appeals where applicable, using all available documentation, coding guidelines, and regulatory references to defend billed claims and secure reimbursement on insurance accounts receivable.
• Investigate the root causes of denials and downgrades, as needed.
• Provide targeted training on coding practices to Currance team members, promoting accuracy, compliance, and efficiency in resolving coding-related issues.
• Participate in daily shift briefings and contribute actively.
• Resubmit corrected claims according to Federal, State, and payer-mandated guidelines.
• Research, analyze, and correct claim errors and rejections to ensure accurate resubmission and to avoid payer denials due to preventable errors.
• Escalate problematic accounts, recurring issues, or trends to Supervisor and recommend education or denial prevention measures to the client.
• Stay current on payer updates, process changes, and coding guidelines to maintain compliance with Federal, State, and payer requirements.
• Meet productivity standards while maintaining quality output.
• Communicate payer-specific issues to the team and management for timely resolution.
• Engage in continuous learning to remain up to date on coding and payer policies.

Denial Resolution Specialist

• Perform internal quality reviews for inpatient and outpatient coding across multiple Health Information Management Service Centers (HSCs).
• Audit medical records to ensure coding accuracy, completeness, and compliance with MS-DRG and national standards.
• Provide feedback, coaching, and documentation support to coders to improve performance and maintain consistency.
• Participate in special review projects and policy-driven audit initiatives.
• Maintain productivity and accuracy rates of at least 95%.
• Keep coding knowledge current by reviewing official data quality standards, coding guidelines, and policy updates.
• Support adherence to internal and external compliance requirements for data and reimbursement accuracy.

Coding Quality Review Specialist

• Accurately assigns appropriate ICD-10-CM and CPT-4 codes to outpatient records
• Abstract essential data elements for tracking, reporting, and reimbursement purposes
• Keying, billing and collections for assigned client databases
• Review and analyze medical records for document deficiencies
• Ensure accurate coding and compliance with Federal and State regulations
• Verify accuracy of patient account, type, and demographic data
• Meet productivity standards set by Revenue Integrity Coding department

Certified Professional Coder

• Reviews complex inpatient documentation at a highly skilled and proficient level to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS
• Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software
• Responsible for coding high dollar and long length of stay cases for all patient types
• Serves as a subject matter expert to Coding department leaders and peers
• Recommends modifications to current policies and procedures as needed to coincide with government regulations
• Collaborates with the Clinical Documentation Improvement and Quality teams to ensure a match in the DRG and reconciles each Medicare case from a CDI perspective
• Responsible for clinician communication related to disease processes on a clinical level to ensure accurate coding
• Participates in payer audits and meetings by acting as a resource for coding-related audits, as requested

Inpatient Coder Specialist – Community Facility

• Accurately assigns diagnosis and procedure codes for inpatient facility and professional services.
• Performs necessary tasks within MHS GENESIS and other military coding systems.
• Accurately assign Evaluation and Management (E&M) codes, ICD-CM diagnoses, CPT and HCPCS, modifiers, and quantities derived from medical record documentation.
• Reviews encounter and/or record documentation to identify and resolve inconsistencies, ambiguities, or discrepancies.
• Assigns accurate codes based on provider responses to coding queries.
• Supports DHA coding compliance by performing due diligence in ethically and appropriately researching and/or interpreting existing guidance.
• Utilizes MHS computer systems to remotely access patient records and assign codes for patient encounters in support of other MTFs.
• Achieve and maintain DHA coding productivity and accuracy standards for the position.
• Educates and provides feedback to providers and clinical staff to resolve documentation issues to support coding compliance.
• Acts as a source of reference to medical staff having questions, issues, or concerns related to coding.
• Responds to provider questions and provides examples of appropriate coding and documentation reference(s).

Medical Coder II

• Review medical records for outpatient or same day surgical procedures
• Assign appropriate diagnostic and procedural codes (CPT and ICD-10)
• Apply appropriate coding classification standards and guidelines to medical record documentation for accurate coding
• Submit necessary provider queries to resolve documentation discrepancies
• Perform quality assessment of records, including verification of medical record documentation
• Review appropriate charges and make changes or recommendations based on the documentation
• Research errors or missing documentation from medical records to provide accurate coding processes
• Abstracts and assigns the appropriate ICD-10-CM and CPT codes for all diagnoses and procedures

Coder, SDS

• Coordinate/review the work of subordinate employees and assist with the training and continuing education programs.
• Code medical records utilizing ICD-10-CM and CPT-4 coding conventions.
• Review the medical record to assure specificity of diagnoses, procedures, and appropriate/optimal reimbursement for hospital and/or professional charges.
• Abstract information from medical records following established methods and procedures.
• Review the complex medical records and accurately code the primary/secondary diagnoses and procedures using ICD-10-CM and/or CPT coding conventions.
• Ensure quality and quantity of work performed through regular audits.
• Assist with research, development, and presentation of continuing education programs on areas of specialization.
• Maintain a thorough understanding of anatomy and physiology, medical terminology, disease processes, and surgical techniques through participation in continuing education programs.

Medical Records Coder II – Outpatient

• Works remotely to code IRF records using current ICD coding version and within timeframe set by supervisor.
• Maintains coding schedule as assigned by the Area Director.
• Works closely with the PPS Coordinator/Outcomes Manager in assigning the Impairment Code for all admissions as well as other newly diagnosed conditions.
• Serves as back-up for the hospital to transmit IRF PAIs in a timely manner for all Medicare inpatients.
• Maintains confidentiality of all patient care information to ensure patient rights are protected.
• Participates in continuing education classes and training programs.
• Completes annual health, safety and education requirements. Maintains professional growth and development.
• Demonstrates knowledge of the principles of growth and development over the life span and the skills necessary to provide age appropriate care to the patient population served.
• Reports to work on time as scheduled; adheres to policies regarding notification of absence.
• Attends all mandatory in-services and staff calls.
• Represents the organization in a positive and professional manner.
• Complies with all organizational policies regarding ethical business practices.
• Works within the mission, vision, ethics and goals of the organization.
• Maintains current licensure/certification for position, if applicable.
• Consistently demonstrates Guest Relation’s skills to physicians, hospital employees and any other individuals with whom they may come in contact.
• Consistently follows organizational and hospital Health, Safety, Security, Hazardous Materials policies and procedures.
• HIPAA: Conduct job responsibilities in accordance with HIPAA privacy laws, follows organizational policies in provision of patient confidentiality. Able to identify patient confidentiality issues and reports to supervisor.
• Compliance: Conducts job responsibilities in accordance with standards set forth in LifePoint’s Code of Conduct, LifePoint policy and procedures, applicable federal and state laws, and applicable standards.
• Able to communicate effectively in English, both verbally and in writing.
• Advanced computer knowledge.
• Knowledge of basic office equipment.
• Appropriate telephone communication skills

IRF Inpatient Coding Specialist

• Reviewing documentation and selecting the appropriate procedure and/or diagnosis code to be entered in billing documents
• Ensuring that teaching physician requirements are met and are clearly reflected in the documentation
• Other duties as assigned

Medical Billing and Coding jobs in Tennessee

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