Jackson Health

Role Description HIM Outpatient Coder 1 is responsible for coding and abstracting outpatient medical records, including Emergency Room visits, Clinic visits, and Recurrent visits. The Coder 1 is responsible for reviewing the clinical documentation contained in the patient health record to accurately assign and sequence ICD-9 and CPT codes for use in reimbursement and data collection. Able to transition to ICD-10-CM. - Codes outpatient diagnostics/outpatient clinics/recurring visits/emergency room visits using ICD-9 or CPT codes as appropriate. - Maintains a yearly average accuracy rate of 94% during internal and/or external Coding audits. - Verifies patient information to identify any discrepancies and ensures that all codes and any other abstracted information is applied to the appropriate patient's encounter. - While reviewing the record for coding purposes, serves as a quality reviewer, and identifies any documents not belonging to the patient, or the correct patient's encounter. - Ensures the accuracy when using the appropriate modifiers while coding out patients encounters. - Assesses documentation and if necessary queries the physician for additional information when indicated to clarify a diagnosis, symptom or any reason for services provided. - Makes sure all codes are utilized to reflect the care rendered to the patient which in return will ensure patient safety, accuracy of data retrieval and provides the organization with accurate reimbursement for the care provided to the patient. - Evaluates to determine that data documented substantiates the diagnosis and treatment and is internally consistent as required by accreditation standards. - Recognizes and reports unusual circumstances and/or information with possible risk factors to the Coding Assistant Administrator, Coding Associate Administrator or the Coding Director. - Meets continuing education requirements established by American Health Information Management Association (AHIMA) and/or American Association of Professional Coders (AAPC) to maintain appropriate certification and competency in job skills and knowledge. - Meets productivity standards according to AHIMA Guidelines depending on outpatient record type (Clinics, ER, Recurrent, Diagnostics). - Is actively involved in all ICD-10 education sessions provided by Jackson Health Systems. - Shows competency according to education received. - Participates in educational requirements by JHS, including but not limited to Safety, Infection Control, AIDS Awareness, etc. - Follows hospital wide and department specific standards for safety and infection control. - Adheres to the Standards of Excellence at all times, and respects the rights, privacy and property of others at all times including the confidentiality of information, according to Administrative Policies HIPAA Guidelines and all applicable laws and regulations. - Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). - Performs other related duties as assigned. Qualifications - Generally requires 0 to 3 years of related experience. - High School diploma is required. Requirements - Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. - Ability to communicate effectively in both oral and written form. - Ability to handle difficult and stressful situations with critical thinking and professional composure. - Ability to understand and follow instructions. - Ability to exercise sound and independent judgment. - Knowledge and skill in use of job appropriate technology and software applications. Credentials - Employee hired AFTER June, 2015 must be credentialed with an HIM/Coding Credentials and/or Certification by AHIMA or AAPC.

Role Description The HIM Outpatient Coder 2 is responsible for coding and abstracting outpatient medical records, including outpatient surgeries, GI procedures, and cardiac catheterizations. The Coder 2 reviews the clinical documentation contained in the patient health record to accurately assign and sequence ICD-9 and CPT codes for use in reimbursement and data collection. Able to transition to ICD-10-CM/PCS. Responsibilities - Codes outpatient surgeries, including GI procedures and cardiac catheterization procedures using ICD-9 or CPT codes as appropriate. - Maintains a yearly average accuracy rate of 94% during internal and/or external coding audits. - Verifies patient information to identify any discrepancies and ensures that all codes and any other abstracted information is applied to the appropriate patient's encounter. - Serves as a quality reviewer while reviewing the record for coding purposes, identifying any documents not belonging to the patient or the correct patient's encounter. - Ensures accuracy when using the appropriate modifiers while coding outpatient encounters. - Assesses documentation and queries the physician for additional information when indicated to clarify a diagnosis, symptom, or any reason for services provided. - Ensures all codes reflect the care rendered to the patient, ensuring patient safety, accuracy of data retrieval, and providing the organization with accurate reimbursement for the care provided. - Evaluates to determine that data documented substantiates the diagnosis and treatment and is internally consistent as required by accreditation standards. - Recognizes and reports unusual circumstances and/or information with possible risk factors to the Coding Associate Administrator or the Coding Director. - Meets continuing education requirements established by AHIMA and/or AAPC to maintain appropriate certification and competency in job skills and knowledge. - Meets productivity standards according to AHIMA Guidelines depending on outpatient record type and is actively involved in all ICD-10-CM/PCS education sessions provided by Jackson Health Systems. - Shows competency according to education received. Qualifications - Generally requires 3 to 5 years of related experience. - At least three years of prior outpatient coding in an inpatient hospital is highly preferred. Education - High School diploma is required. Credentials - Employee hired AFTER June 2015 must be credentialed with an HIM/Coding Credential and/or Certification by AHIMA or AAPC. AHIMA ICD10-CM-PCS Trainer preferred.

***** Experience in Health Insurance, Surgical cases and CPT codes Shift; Days Location: Remote Miami, FL Full-Time Financial Clearance Center (FCC) Summary Authorization & Clearance Specialist plays a critical role in ensuring that medical services provided to patients are covered by the patient's insurance providers. They are responsible for obtaining pre-authorizations, initiating authorizations, extending concurrent authorization, verifying insurance coverage for medical procedures, treatments, hospital stays, initiating retroactive authorization modifications, and discharge notifications as appropriate. Responsibilities Identifies and confirms valid coverage for an episode of care and/or specific service: contacts insurance companies and/or reviews electronic response summary and coverage discovery information to ensure the appropriate coverage coordination are on the patient's record. Initiates authorization with patient insurance by submitting necessary clinical documentation, continues to follow up, obtain and validate authorization/referrals/notifications with appropriate CPT, ICD-10 codes, Tax ID and NPI #s within the appropriate timelines. Works daily work queues according to department directives, to identify patients requiring authorization for services scheduled and non-scheduled appropriately prioritizing work assignments based on scheduled appointment date/time, medical severity, payer assignments, dollar value etc. Verifies that the services the patient is set to receive is a covered benefit, validates benefit package restrictions, and completes quality assurance checks on authorization patient type, facility, etc. Understands patient deductibles, out of network referrals, out of pocket limitations, and lifetime/event caps on liability. Refers patients to appropriate Financial Counselor, Prior Authorization or Billing based on financial coverage, financial situation, employment status, liability and/or patient concern. Uses insurance discovery tools available to attempt to validate any and all insurance coverage, ensure correct insurance coordination of benefits are listed on patient's record, follows up with patient/next of kin/Social Work/Case Management in order to obtain insurance coverage information. Verify all insurance and obtain pre-certification/authorization for services, as warranted, and notifying patient and referring physician in the event of failed eligibility and/or authorization. Follows up with and escalates as appropriate to physician's office/clinical teams/Case Management for any pending clinical documentation, including peer-to-peer requests. Diligently follows up on any pending authorizations to ensure information is processed with the insurance payer within appropriate timelines. Works directly with JHS medical services to ensure procedures, diagnoses, level of care, are sufficient for each case by following CMS and payer guidelines and communicating with medical team for corrections. Maintain knowledge base of all programs offered by JHS for Charity and Financial Assistance and the requirements to qualify, with the process for Charity Care clearance of scheduled procedures and coverage. Calculates patients' financial responsibility based on patient benefits using the estimator tools and includes communication with the patients on the out of pocket due at service. Coordinate Self-pay Package pricing by utilizing tools available and escalating to Managed Care team to obtain appropriate package price amounts not found on list or complex contracts. Receives and processes all patient payments in accordance with JHS Collections Policy and Procedure, issues receipt and maintains the integrity of all payments. Scans/uploads all required documents into the appropriate folder in the documenting imagining system in a timely manner to assure maximum reimbursement and compliance. Assist in supporting go lives of new systems and different department initiatives, including onboarding and training team members. Cross-trained in multiple areas/service lines/payers to substitute all staff positions as needed. Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). Performs other related job duties as assigned. Experience Generally requires 0 to 3 years of related experience. Financial clearance experience is strongly preferred. Education High school diploma is required. Bachelor's degree in related field is strongly preferred. Skill Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. Ability to communicate effectively in both oral and written form. Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. Ability to exercise sound and independent judgment. Knowledge and skill in use of job appropriate technology and software applications. Credentials Valid license or certification is required as needed, based on the job or specialty. Unit Specific Credential Working Conditions Physical Requirements - Job function is sedentary in nature and requires sitting for extended periods of time. Function may require frequent standing or walking. Must be able to lift or carry objects weighing up to 20 pounds. Jobs in this group are required to have close visual acuity to perform activities such as: extended use of computers, preparing and analyzing data and analytics, and other components of a typical office environment. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC). Environmental Conditions - Jobs in this group are required to function in a fast paced environment with occasional high pressure or emergent and stressful situations. Frequent interaction with a diverse population including team members, providers, patients, insurance companies and other members of the public. Function is subject to inside environmental conditions, with occasional outdoor exposures. Possible exposure to various environments such as: communicable diseases, toxic substances, medicinal preparations and other conditions common to a hospital and medical office environment. May wear Personal Protective Equipment (PPE) such as gloves or a mask when exposed to hospital environment outside of office. Reasonable accommodations can be made to enable people with disabilities to perform the described essential functions. Additional information and provision requests for reasonable accommodation will be provided by the home unit/department in collaboration with the Reasonable Accommodations Committee (RAC).