Company : Allegheny Health NetworkJob Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES - Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. (65%) - Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) - Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) - Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. (5%) - Performs other duties as assigned or required. (5%) QUALIFICATIONS: Minimum - High School/GED - Successful completion of coding courses in anatomy, physiology and medical terminology - 1 year of Hospital and/or Physician Coding - 1 year coding at mid-level facilities or clinics - 1 year coding major surgeries, observations and/or E/Ms - Medical Terminology - Strong data entry skills - An understanding of computer applications - Ability to work with members of the health care team - Any of the following: - Registered Health Information Technician (RHIT) - Registered Health Information Associate (RHIA) - Certified Coding Specialist Physician (CCS-P) - Certified Professional Coder (CPC) - Certified Outpatient Coder (COC) Preferred - Associate's Degree in Health Information Management or related field Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $21.32 Pay Range Maximum: $34.39 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

Company : Allegheny Health NetworkJob Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD and CPT coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES - Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD-10 CM/CPT codes for diagnoses and procedures. (65%) - Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) - Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) - Keeps informed of the changes/updates in ICD-10 CM/CPT guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these updates in daily work. (5%) - Performs other duties as assigned or required. (5%) QUALIFICATIONS: Minimum - High School/GED - Successful completion of coding courses in anatomy, physiology and medical terminology - 1 year of Hospital and/or Physician Coding - 1 year coding at mid-level facilities or clinics - 1 year coding major surgeries, observations and/or E/Ms - Medical Terminology - Strong data entry skills - An understanding of computer applications - Ability to work with members of the health care team - Any of the following: - Registered Health Information Technician (RHIT) - Registered Health Information Associate (RHIA) - Certified Coding Specialist Physician (CCS-P) - Certified Professional Coder (CPC) - Certified Outpatient Coder (COC) Preferred - Associate's Degree in Health Information Management or related field Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job. Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies. As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy. Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements. Pay Range Minimum: $21.32 Pay Range Maximum: $34.39 Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets. Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org California Consumer Privacy Act Employees, Contractors, and Applicants Notice

About Us We are Emerus, the leader in small-format hospitals. We partner with respected and like-minded health systems who share our mission: To provide the care patients need, in the neighborhoods they live, by teams they trust. Our growing number of amazing partners includes Allegheny Health Network, Ascension, Baptist Health System, Baylor Scott & White Health, ChristianaCare, Dignity Health St. Rose Dominican, The Hospitals of Providence, INTEGRIS Health, MultiCare and WellSpan. Our innovative hospitals are fully accredited and provide highly individualized care. Emerus' commitment to patient care extends far beyond the confines of societal norms. We believe that every individual who walks through our doors deserves compassionate, comprehensive care, regardless of their background, identity, or circumstances. We are committed to fostering a work environment focused on teamwork that celebrates diversity, promotes equity and ensures equal access to information, development and opportunity for all of our Healthcare Pros. Position Overview The purpose of this position is to review medical records documentation to select and sequence the appropriate ICD-10-CM diagnosis codes, verify the correct CPT-4/HCPCS procedure codes are attached and to capture charges for laboratory, radiology, supplies and medical procedures within the following types of records: Emergency Facilities, Inpatient, Observation and Ancillary services. Essential Job Functions - Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and CPT-4 to include IV infusion and injection codes - Review clinical documentation and diagnostic results to extract data and apply HCPCS and facility level Evaluation & Management codes for billing - Abstract and code diagnoses and procedures from health records by using appropriate classification systems Other Job Functions - Attend staff meetings or other company sponsored or mandated meetings as required - Perform additional duties as assigned - Ability to work off hours and overtime Basic Qualifications - High School Diploma or GED, required - CPC, CPC-H, CIC, COS or CCS, or other coding certification, preferred, OR RHIA or RHIT certification with 3+ years of experience, required - 3+ years experience coding using ICD-10-CM, HCPCS and CPT codes, required - Experience coding emergency or hospital ancillary services, preferred - Expertise in pathophysiology, anatomy, medical terminology, coding systems, techniques and procedures, preferred - Proficiency using Microsoft Office Tools (Microsoft Word, Excel and Outlook), required - Proficiency with patient accounting systems, preferred - Experience using Stockell InsightCS patient accounting system, EPIC Community Connect, Cerner and/or PICIS EMR, preferred - Experience and knowledge calculating and applying IV Infusion and Injection codes, preferred - Knowledge of all Health Insurance Portability and Accountability Act (HIPAA) guidelines and regulations, required - ICD 10 Training/Education - Position requires fluency in English; written and oral communication

Description Are you searching for a fulfilling role that can make a significant difference in healthcare? At Innovista, we're devoted to driving transformative change in this essential sector. Our independent physician partners achieve exceptional results in every aspect of value-based care, contributing to enhanced patient care and improved practice outcomes. Innovista Health is a full-service management services organization with a commitment to revolutionizing practice, offering solutions like multi-payer program administration, quality, utilization, and care coordination services, as well as performance improvement insights and reporting. Innovista Health Solutions, based in Illinois, is an organization with a far-reaching influence, operating in both Illinois and Texas. At Innovista, we trust in the power of innovative programs and dedicated people to propel us forward in today's ever-changing healthcare market. This fully remote position is a fantastic opportunity for you to become a part of our Houston, TX team, leading the charge toward a superior, more efficient healthcare system. JOB SUMMARY: Provide internal support to the Medical Management Department in the areas of Outpatient Case Management ensuring all services referred are reviewed according to plan requirements and approved criteria. DUTIES AND RESPONSIBILITIES: - Effectively communicates to management and internal departments timely. - Receives and responds to all incoming calls from PCP, specialists, and other providers regarding inpatients, surgeries, and outpatient services including DME, Home Health Care, and other services requiring a pre-authorization. - Coordinates DME with contracted HMO vendors for outpatient services. - Coordinate with Inpatient Case Manager on discharge planning of members (DME, Home Health, and Skilled Nursing). - Coordinates and reviews retro surgical procedures with Manager. - Understands Health Plan policies and procedures regarding pre-authorization, benefits by health plan, and preferred facilities within each plan. - Enters data and coordinates elective admissions with a surgical component. - Maintains compliance with all health plan guidelines on the reporting of cases/surgeries. - Works with clinical staff to assess benefit levels for non-medical denial determination to ensure the denial process includes letter and log maintenance. - Identifies potential stop-loss candidates to be monitored and reports to a senior-level manager. - Applies Innovista guidelines and additional approved criteria as detailed in the client UM Plan for the length of stay/admission criteria to approve initial and continued inpatient services. - Other duties as assigned. Requirements - High School Diploma or equivalent experience required. - At least 2-3 years of relevant professional experience, including managed care and quality. - Being knowledgeable in using InterQual and/or MCG (Milliman) guidelines is a plus. - Able to effectively communicate technical concepts and basic business concepts with team members and internal customers. BENEFITS: At Innovista, we prioritize attracting talented individuals who embody our core values of integrity, determination, and teamwork. We understand the significance of balancing personal life with work commitments and hence offer a comprehensive benefits package to support our team. Our offerings include: - A robust health benefits package with subsidized medical insurance, including Flexible Spending Account (FSA), Health Savings Account (HSA), and Health Reimbursement Account (HRA) options, complemented by dental and vision coverage. - Assurance of financial security with company-paid benefits such as short and long-term disability, employee life, and Accidental Death and Dismemberment (AD&D) policies. - A yearly discretionary bonus, enhancing your financial prospects. - A generous paid time off policy that appreciates and rewards your loyalty and tenure with the company. - Paid company holidays and parental leave, ensuring time for relaxation and family. - Access to our Employee Assistance Program, supporting you in times of need. - A 401(k) scheme with a company match, supporting your future financial stability. - The opportunity for flexible work arrangements including remote or hybrid work, and potentially adjustable work hours. - Opportunities for continuous education, fostering personal growth and development. - A "Dress for Your Day" policy, promoting comfort and individuality. - Access to discounted gym memberships via medical coverage, promoting wellness and health. - Clear career advancement and growth pathways, recognizing your hard work and ambition. - Rewarding employee referral bonuses for expanding our team with like-minded individuals. - An open-door policy that encourages direct communication with our CEO and upper management, fostering transparency and inclusivity in our work culture.