Department: 10351 Enterprise Revenue Cycle - Coding Production Operations: Administrative Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Will support: - Facility Inpatient Pre-Bill Schedule: - Monday-Friday, Flexible hours, Remote work Certification desired: - Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA). Remote opportunity: Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WY Pay Range $28.55 - $42.85 - Prioritizes and codes and abstracts high dollar charts, day after discharge, as well as interim charts, at regular intervals, with a high degree of accuracy. - Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals to assign diagnosis and procedure codes utilizing ICD 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. Assigns codes for present on admission, research, Hospital acquired Conditions and Core Measure Indicators for all diagnoses both concurrently and post-discharge. - Collaborates with other departments to clarify pre-bill coding documentation issues such for inpatient and outpatient to insure reimbursement and clinical outcomes. - Works claim edits for all patient types and may codes consecutive/combined accounts to comply with the 72-hour rule and other account combine scenarios. - Completes informal peer-review on inpatient and outpatient coders. - Tracks and trends quality information from internal and external sources to partner with the educational team on opportunities. - Communicates with Medical Staff, CDI, Post -bill for documentation clarification. - Utilizes EMR communication tools to track missing documentation on inpatient queries that require follow-up to facilitate coding in a timely fashion. Partners with HIM, Patient Accounts, and Integrity, when needed, to help resolve issues affecting reimbursement and outcomes. - Maintains current knowledge of changes in Inpatient coding and reimbursement guidelines and regulations as well as new applications or settings for coding all types of patients. - Must be able to use critical decision-making skills to determine when to query to clarify documentation independently for outcomes, reimbursement and benchmarking. License/Registration/Certification: - Must have a certification through American Health Information Management Association (AHIMA) or American Academy of professional Coders (AAPC) Education: - Two Year associate degree or equivalent work experience Experience: - Five to Seven years of inpatient coding experience in an acute care inpatient setting in an Academic Inpatient Care Tertiary Facility Knowledge, Skills & Abilities Required: - Advanced proficiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology. - Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications. - Excellent communication (oral and written) and interpersonal skills. - Excellent organization, prioritization, and reading comprehension skills. - Excellent analytical skills, with a high attention to detail. - Ability to work independently and exercise independent judgment and decision making. - Ability to meet deadlines while working in a fast-paced environment. - Ability to take initiative and work collaboratively with others. Physical Requirements and Working Conditions: - Exposed to a normal office environment. - Must be able to sit for extended periods of time. - Must be able to continuously concentrate. - Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards. - Operates all equipment necessary to perform the job. - This job description indicates the general nature and level of work expected of the incumbent. It is not designed - to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. #REMOTE #LI-Remote Our Commitment to You: Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including: Compensation - Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training - Premium pay such as shift, on call, and more based on a teammate's job - Incentive pay for select positions - Opportunity for annual increases based on performance Benefits and more - Paid Time Off programs - Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability - Flexible Spending Accounts for eligible health care and dependent care expenses - Family benefits such as adoption assistance and paid parental leave - Defined contribution retirement plans with employer match and other financial wellness programs - Educational Assistance Program About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise. It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community benefits.

Position Summary: As a valued member of the DRG Review Team, the DRG Integrity Specialist performs a secondary level review of medical records and code assignment using knowledge of Accuity technology and client systems with a physician in accordance with federal coding regulations and guidelines as well as client specific coding guidelines to ensure accurate DRG assignment. This function requires a broad knowledge of the compliance structure to support the appropriate reimbursement. Primary Job Responsibilities: - Review pre-bill cases simultaneously with a physician during each work shift excluding breaks and meetings to analyze and validate diagnosis and procedure codes for inpatient services via coding compliance and clinical knowledge to support accurate DRG assignment - Utilizes Accuity technology for tracking of coding errors, query opportunities and other data collection as needed - Researches, analyzes, and responds to inquiries regarding compliance, inappropriate coding, and client denials - Possesses a high level of dependability and ability to meet Accuity coding recommendations, accuracy rate, and production standards - Interacts with Accuity physicians, peers, CDIS, and management regarding documentation, policies, procedures, and regulations - Interacts with management on an ongoing basis including assisting senior level staff in providing recommendations for process improvement so that productivity and quality goals can be met or exceeded, and operational efficiency and financial accuracy can be achieved - Reviews, develops, modifies, and/or adapts relevant client procedures, protocols, and systems to coordinate with Accuity methodology - Creates and provides group education and training based on accurate coding practices, coding compliance documentation, and regulatory provisions - Attends in-house training sessions to receive updated coding information and changes in coding and/or regulations - Adheres to stringent timelines consistent with project deadlines and directives - Ensures strict confidentiality of patient medical records - Always acts in an ethical and collaborative manner while monitoring own work to help ensure quality - Codes medical records as needed based on organizational needs - Performs miscellaneous job-related duties as assigned Position Qualifications: Education: - High School Diploma or GED required - Associates Degree in Health Information Management or similar preferred Experience: - Minimum 4 years of inpatient coding experience in hospital facility coding - Minimum 2 years of experience that is directly related to the duties and responsibilities specified above - Experience and knowledge in DRG reimbursement (i.e., MS-DRG, APR-DRG) Licensure and/or Credentials: - Coding credential required from AHIMA/AAPC (RHIA, RHIT, CCS and/or CPC, or CIC) Knowledge, Skills, and Abilities: - Knowledge of auditing concepts and principles - Expert of coding guidelines Ability to use independent judgment and to manage and impart confidential information - Advanced knowledge of medical coding, electronic medical record systems, coding systems - Critical thinking skills to analyze and solve problems - Strong communication and interpersonal skills - Knowledge of legal, regulatory, and policy compliance issues related to medical coding and documentation - Knowledge of current and developing issues and trends in medical coding diagnosis and procedure code assignment - Ability to clearly communicate medical information to physicians and CDIS staff - Ability to provide guidance and training to when needed - Ability to use a PC in a Windows environment, including MS Word - Independent, focused individual able to work remotely or on-site Physical Requirements: The requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job with or without reasonable accommodations. Unless otherwise indicated, Accuity positions require interaction with people and technology while either sitting or standing. Employees must be able to communicate via phone, email, etc. and sit for extended periods of time, with or without reasonable accommodations. Physical effort and exposure to physical risk are limited to that of an office role environment. While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from a job and to assign other duties as necessary and at any time. All positions at Accuity are at-will employment, and a position description is not a guarantee of a job or of job responsibilities.

EDUCATION & EXPERIENCE: Minimum Qualifications: - Three years of multi-specialty coding experience. - Proficient in coding Professional services, and/or Outpatient professional and hospital technical services. - Experience with communicating, training, and educating providers in proficiency. Preferred Qualifications: - Knowledge of coding guidelines, anatomy and physiology, biology and microbiology, medical terminology and medical abbreviations. REQUIRED LICENSES, REGISTRATIONS, OR CERTIFICATIONS: One of the following: - CCA – Certified Coding Associate (AHIMA) or - CCS – Certified Coding Specialist (AHIMA) or - CCS-P – Certified Coding Specialist – Physician Based (AHIMA) or - RHIA – Registered Health Information Administrator (AHIMA) or - RHIT – Registered Health Information Technician (AHIMA) - CIC – Certified Inpatient Coder (AAPC) or - COC – Certified Outpatient Coder (AAPC) or - CPC – Certified Professional Coder (AAPC) or - CPC-A – Certified Professional Coder – Apprentice (AAPC) or - CRC – Certified Risk Adjustment Coder (AAPC) JOB SUMMARY: Properly codes and/or audits professional services for inpatient and/or professional and hospital outpatient technical services for multiple specialty areas to ensure accuracy and optimal reimbursement from all third-party payers. ESSENTIAL JOB FUNCTIONS: - Reviews documentation in EPIC and/or on paper as provided to appropriately assign ICD-10-CM, PCS and CPT codes. - Communicates with and provides feedback to the education team and/or provider for query opportunities for documentation clarification or missing elements in the medical record. - Utilizes the encoder and/or Optum software to correctly assign all appropriate ICD-10-CM, ICD10-PCS and CPT codes for diagnosis and procedures. - Sequences diagnoses and procedures to generate clean claims in accordance with the Coding Guidelines based on the type of coding being reviewed. - Verifies all ADT information is correct on all charge sessions; date of service, billing provider, service provider, place of service, referral information and claim form if required. - Attends and participates in coding education sessions. - Obtains required CEU’s for certification and completes any required education. - Works coding related charge reviews/claim edits daily to ensure timely and accurate billing within filing deadlines. - The coder is responsible for productivity and quality standards to adhere with coding compliance and federal regulations. - Work all PB/HB claim edits and reject errors daily. - Hospital DNB’s will be worked as assigned per Specialty. - Work charge reconciliation to ensure all services provided are captured for coding in a timely manner. - Adheres to internal controls and reporting structure. Marginal or Periodic Functions: - Performs related duties as required. KNOWLEDGE/SKILLS/ABILITIES: - Strong written and oral communication skills. WORKING ENVIRONMENT/EQUIPMENT: - Standard office environment at UTMB’s main campus or other location. - Occasional travel may be required. - Standard office equipment SALARY RANGE: Actual salary commensurate with experience. WORK SCHEDULE: Remote position. Casual Appointment (up to 19.99 hours/week). Equal Employment Opportunity UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

• Audit patient medical records using clinical, coding, and payer guidelines to ensure accurate reimbursement. • Provide clear, evidence-based rationale for code recommendations or reconsiderations to providers or payers. • Collaborate with team leaders to ensure thorough review of DRG denials. • Conduct audits in alignment with organizational quality and timeliness standards. • Use proprietary auditing systems proficiently to make consistent determinations and generate audit letters. • Recommend improvements to the audit system to enhance efficiency. • Ensure compliance with HIPAA regulations for protected health information. • Perform other duties as assigned.