Affordable Housing Trust for Columbus and Franklin County

• Generate comprehensive first-level, second-level, and escalated appeal letters for denied claims. • Develop compelling clinical arguments using medical records, physician documentation, industry standards, and payer policies. • Create appeal packages with all required supporting documentation and submit within payer timelines. • Track appeal status, deadlines, and outcomes to ensure timely follow-up. • Review and revise appeal content to improve quality, consistency, and overturn success rates. • Review and assess denials related to: • Medical necessity • Level of care • Clinical validation • Authorization issues • Audit findings • Conduct detailed chart reviews to validate payer rationale and determine appeal viability. • Analyze denial trends and identify opportunities for overturn and prevention. • Apply CMS regulations, Medicare guidelines, LCDs, NCDs, payer policies, and industry guidance to support appeal arguments. • Maintain current knowledge of ICD-10-CM/PCS coding requirements, DRG methodologies, and reimbursement regulations. • Monitor payer updates and regulatory changes impacting denials and appeals. • Assist in developing appeal templates, reference materials, and best practices. • Provide recommendations to improve appeal effectiveness and reduce future denials. • Contribute to denial prevention initiatives through trend analysis and education. • Partner with physicians, CDI specialists, case management, utilization review, coding, and HIM teams to strengthen appeal outcomes.

• Conduct coding audits of outpatient facility services, including ancillary procedures, PET scans, and simple visit encounters, to ensure coding accuracy and regulatory compliance. • Perform comprehensive audits and reviews of professional Evaluation and Management (E/M) documentation and coding to validate code assignment and reimbursement accuracy. • Provide ongoing feedback, education, and coaching to coding staff to improve coding quality, consistency, and adherence to coding guidelines. • Review and analyze clinical documentation and assigned codes from a variety of medical records to ensure accurate ICD-10-CM, CPT, and other applicable code assignment in accordance with current coding standards, regulatory requirements, and client-specific policies and guidelines.

• Review and evaluate medical record documentation for completeness, accuracy, and compliance. • Collaborate with physicians, nurses, and coding professionals to ensure appropriate clinical documentation. • Identify opportunities for documentation improvement to support coding accuracy, reimbursement, and clinical outcomes. • Analyze medical records to ensure documentation supports quality care and appropriate reimbursement. • Formulate compliant, clinically sound physician queries.

• Perform comprehensive charge audits for inpatient and outpatient services. • Review itemized billing statements against medical records to verify accuracy and completeness. • Identify and document: • Missing charges • Duplicate charges • Unsupported or non-compliant charges • Validate charges based on clinical documentation, coding rules, and billing guidelines. • Ensure all billing aligns with: • CMS and payer requirements • National healthcare billing audit guidelines • Organizational compliance standards • Submit clear, actionable audit findings to revenue cycle teams for correction and rebilling. • Analyze audit findings to determine root causes and patterns. • Maintain accurate audit documentation that is clear, traceable, and defensible. • Track audit outcomes and financial impact. • Assist in developing recommendations to improve charge capture accuracy and billing processes. • Partner with: • Coding and billing teams • Clinical departments • Revenue cycle leadership • Provide guidance on: • Documentation requirements • Charge capture practices • Billing compliance standards • Support education efforts to prevent recurring audit issues.

• Join an award-winning team and work with the best! • Use and enhance coding expertise while enjoying the flexibility and comfort of working from home. • Seek out experienced Surgical Profee Coders who are CPT coding experts in professional billing of surgical cases performed in both inpatient and outpatient settings.

• Perform accurate code assignments for ED records (facility and profee) • Work remotely from a home office • Utilize and enhance current coding skills • Maintain coding quality of 95% or greater • Adapt well to change and demonstrate flexibility

• Perform accurate code assignments while working remotely from a home office. • Adapt well to change and work independently. • Maintain coding quality of 95% or greater. • Meet client productivity targets.

• Perform accurate code assignments for facility outpatient, same day surgery and observation records. • Utilize and enhance coding expertise in an exciting and fulfilling role. • Work from home with flexibility and comfort.

• Code and audit a variety of records including interventional radiology, cardiology, cardiac cath’s, cardiothoracic surgery, vascular surgery, general surgery and orthopedics • Utilize and enhance coding expertise in a remote work environment

• Perform accurate code assignments for ED records (facility and profee). • Work remotely from a home office. • Adapt well to change and maintain coding quality of 95% or greater. • Collaborate with the team while meeting productivity targets.