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

• 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

• Responsible for primary diagnosis and procedural coding for designated ambulatory and hospital outpatient setting
• Assign proper and accurate medical codes for diagnosis, procedures, and services performed in an outpatient setting
• Review medical record documentation to identify pertinent diagnosis/procedures that require code assignment
• Ensure specificity of diagnoses and procedures for appropriate reimbursement
• Query physicians when code assignments are not straightforward or documentation is inadequate
• Maintain 95% or greater ICD-10-CM and/or HCPCS coding accuracy
• Abide by the Standards of Ethical Coding set forth by AHIMA
• Ensure safe care to patients, staff and visitors
• Promote individual professional growth and development by meeting requirements for continuing education

Certified Outpatient Coding Specialist

• Reviews and interprets health record documentation to accurately identify pertinent primary and secondary diagnosis and procedures that require code and DRG assignment for properly billing inpatient records
• Presents on Admission indicators and calculates the correct MS-DRG, Severity of Illness and Risk of Mortality levels per official coding guidelines, THR coding compliance policies and procedures, CMS and other third party payers to ensure accurate reimbursement
• Assesses high risk quality cases to accurately trigger pre-bill coding review process
• Abstracts and complies clinical data elements such as attending physician, surgeon, consultants, ED physician, birth weight, etc. according to THR guidelines
• Validates and initiates correction on patient status, admit and discharge dates and discharge disposition for calculation of correct DRG and length of stay for correct reimbursement
• Queries physician when documentation in the record is ambiguous, inadequate, unclear or incorrect for coding and compliance purposes
• Collaborates with Clinical Documentation Specialist to improve coding and documentation
• Demonstrates and maintains adequate productivity and coding quality metrics as outlined in job description
• Demonstrates and maintains coding proficiency by staying abreast of coding guidelines as published in Coding Clinic
• Demonstrates timely completion of all THR training and education as well as maintains credentials by completing assigned continuing education credits per THR Coding Compliance requirements

Coder II – Inpatient

• The Medical Billing Specialist is responsible for the timely and accurate submission of insurance claims, reviewing and updating denied claims for resubmission and performing reconciliations to ensure timely billing for services provided.
• The Medical Billing Specialist collaborates with patients, revenue cycle counterparts and work units, clinical staff, and insurance providers to drive the efficiency of the billing process and reduce the amount of denied claims.
• Reviews patient demographic and insurance information and confirms patient benefit details related to services provided by the clinic from insurance providers.
• Obtains necessary medical documentation from clinicians to provide to insurance companies as required for review and prior authorization of treatment.
• Documents authorization reference numbers in EMR and/or other systems.
• Updates and maintains EMR and/or other systems based on documentation provided by physician/clinic for creation of medical claim and/or posting of self-pay charges to patient accounts.
• Prepares electronic claim files for submission.
• Monitors accepted/denied claims and updates claims as required for resubmission.
• Compares transaction reports with daily schedules to ensure timely billing of all services provided each month.
• Resolves and prepares paperwork for any credit balances and prepares statements for collection of outstanding patient balances.
• Performs daily charge capture functions as outlined by each Clinic in a timely and appropriate manner. This includes but not limited to the actual data entry of charges per patient into the EMR platform, eIVF.
• Ensures charge reconciliation to the schedule for all patients seen daily.
• Ensures appropriateness of charges based upon services rendered and works in conjunction with Clinic leadership, RCM Leadership, and Coding Team to ensure such accuracy.

Medical Billing Specialist – Women's Health

• 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

• Review medical records and assign codes using ICD-10, CPT, and HCPCS Level II systems
• Ensure coding accuracy and compliance with regulatory standards
• Examine chart elements and verify the accuracy of medical records
• Prepare and submit coded information for insurance claims
• Follow CPT/ICD-10 coding guidelines and legal requirements to ensure compliance with HIPAA

Medical Coder

• 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

• Reviews documentation for appropriate attestation, signatures, and dates
• Abstracts and codes surgical procedures from all sections of CPT
• Codes ICD10
• Abstracts anesthesia times and events
• Identifies care team providers
• Reviews for medical direction
• Meets team KPIs including daily production and quarterly coding audit score requirements
• Works complex edits and denials
• Adheres to all HIPAA and confidentiality

Production Coding Specialist III

• 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

• Codes Anesthesia charge tickets
• Reviews CPT, ICD-10, ASA and HCPCS coding on charge tickets
• Reviews anesthesia records for supporting documentation for charge tickets
• Reviews medical records for supporting documentation for charge tickets
• Identifies cosmetic and/or prepaid cases and ensures two tickets are created, one for insurance and one for patient responsibility
• Delivers coded charts to assigned box for delivery to billing department
• Assists Billing and AR Department as needed
• Maintains strictest confidentiality

Certified Coder – Anesthesia

• 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

• Performing coding and abstracting of both inpatient and outpatient medical records in accordance with ICD-10-CM and CPT coding rules, guidelines, and conventions following hospital and PAM Health system procedures.
• Accurately reflect the reason for admission, extent of care received, and level of severity of illness.

Facility Rehab Coder, HIM Coder

• 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

• Conducts quality assurance coding of medical records and ICD-10 diagnosis codes
• Assumes ownership and leads advanced and highly specialized administrative/operational/customer support duties
• Ensures coding is accurate and properly supported by clinical documentation within the health record
• Reviews medical records to report conditions that map to HCCs
• Follows state and federal regulations and internal policies
• Works on projects that may include making phone calls to providers
• Participates on special projects, in addition to daily responsibilities

Risk Adjustment Coder

• Responsible for reviewing clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM/CPT4 codes
• Accurately code conditions and procedures as documented in the ICD-10-CM Official Guidelines for Coding and Reporting
• Assigns codes for diagnoses, treatments, and procedures for outpatient encounters
• Utilizes coding principals and reimbursement expertise to assign appropriate ICD-10-CM diagnoses, CPT 4, E&M Levels and modifiers
• Reviews documentation to extract and enter data for other abstracting fields
• Follow coding compliance policies and procedures affecting the coding process

Coder II

• Review provider documentation of diagnostic data from medical records to verify that all Medicare Advantage, Affordable Care Act (ACO) and Commercial risk adjustment documentation requirements are met, and to deliver education to providers on either an individual basis or in a group forum, as appropriate for all IPAs managed by the company.
• Review medical record information on both a retroactive and prospective basis to identify, assess, monitor, and document claims and encounter coding information as it pertains to Hierarchical Condition Categories (HCC).
• Perform code abstraction and/or coding quality audits of medical records to ensure ICD-10- CM codes are accurately assigned and supported by clinical documentation to ensure adherence with CMS Risk Adjustment guidelines.
• Interacts with physicians regarding coding, billing, documentation policies, procedures, and conflicting/ambiguous or non-specific documentation.
• Prepare and/or perform auditing analysis and provide feedback on noncompliance issues detected through auditing.
• Maintain current knowledge of coding regulations, compliance guidelines, and updates to the ICD-10 and HCC codes, Stay informed about changes in Medicare, Medicaid, and private payer requirements.
• Provides recommendations to management related to process improvements, root-cause analysis, and/or barrier resolution applicable to Risk Adjustment initiatives.
• Trains, mentors and supports new employees during the orientation process. Functions as a resource to existing staff for projects and daily work.
• Provides peer to peer guidance through informal discussion and overread assignments. Supports coder training and orientation as requested by manager.
• May assist or lead projects and/or higher work volume than Risk Adjustment Coding Specialist I.
• Other duties as assigned.

Medical Billing and Coding jobs in Texas

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