• Responsible for validating coding and facilitation of appeals process for all assigned denied professional service claims. • Communicates with providers regarding coding denial issues. • Ensures documentation supports CPT, Modifiers, HCPCS and ICD-10 codes for submitted appeals, reopenings, reconsiderations, etc. • Serves as a subject matter expert for assigned specialty. • Utilizes appropriate coding software and coding resources in order to determine correct codes. • Communicates billing related issues to assigned supervisor/manager. • Follows departmental policies for charge corrections. • Provides feedback to providers or appropriate office liaison in order to clarify and resolve coding concerns. • Submits appeals for assigned payer and/or division.

Role Description - Review and label in-patient clinical documentation, including EHR data and discharge summaries. - Identify and validate diagnoses, comorbidities, complications (CC/MCC), procedures, and treatment pathways. - Audit annotated datasets for clinical accuracy, documentation completeness, and coding integrity. - Provide expert input on CDI best practices, coding guidelines, and documentation standards. - Evaluate AI-generated clinical summaries and coding suggestions for accuracy. - Contribute to clinical documentation and coding standards for AI training workflows. Qualifications - Must-Have: - MD or DO degree (Internal Medicine strongly preferred). - Board-certified or board-eligible in Internal Medicine. - Active medical license in good standing. - 2+ years of in-patient / hospitalist experience. - Experience in Clinical Documentation Improvement (CDI) and/or medical coding. - Preferred: - Relevant certifications: CCS, CDIP, CCDS, or similar. - Experience in academic or large hospital systems. Company Description Mercor connects elite creative and technical talent with leading AI research labs. Headquartered in San Francisco, our investors include Benchmark, General Catalyst, Peter Thiel, Adam D'Angelo, Larry Summers, and Jack Dorsey.

Role Description As a Patient Support Medical Claims Processing Representative, you will provide payment assistance solutions such as co-pay cards or vouchers. The primary responsibilities include: - Receiving medical claims from HCPs or patients. - Ensuring adequate supporting documentation has been provided. - Interpreting the EOB/CMS1500. - Vetting the claim against program specific business rules. - Determining if the claim should be paid or rejected. - Providing support for customer requests via telephone, email, fax, or other available means of contact to the Support Center. - Recognizing operational challenges and suggesting recommendations to management as necessary. - Working 40 hours per week (shifts available: 9:00 am – 6:00 pm EST, 10:00 am - 7:00 pm ET, or 11:00 am EST – 8:00 pm EST) under moderate supervision. Qualifications - High School Diploma or equivalent. - Experience in claim processing required. - Medical Billing Certification required. - Coding Certification required. - Ability to interpret Explanation of Benefits (EOB). - HIPAA certified. - Customer Service Experience preferred. - Pharmacy Technician experience preferred. - Bi-lingual (English/Spanish) preferred. Requirements - Exceptional organizational skills are required. - Ability to work 40 hours per week under moderate supervision. Benefits - The pay range for this role is $23.00 per hour. Company Description IQVIA is a leading global provider of clinical research services, commercial insights, and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide.

Role Description Reporting to the HIM Manager Coding and Education, this position will provide education primarily to the Prisma Health coding staff and indirectly to Clinical Documentation Integrity (CDI) staffs, clinicians, billers, and other appropriate hospital personnel. Collaborate with the HIM coding leadership to develop educational programs to ensure coders develop and sustain proficient understanding of all coding regulations, quarterly and annual coding updates, applicable clinical knowledge, and national, fiscal intermediary and organizational specific coding and reimbursement guidelines. To perform charge capture and coding by assigning International Classification of Diseases-Clinical Modification (ICD-CM), International Classification of Diseases-Procedure Coding System (ICD-PCS) codes as well as the Diagnosis Related Group (DRG) assignment, Major Complications and Comorbidities/Complications and Comorbidities (MCC/CCs) and Hospital-Acquired Condition/Patient Safety Indicator (HAC/PSI) capture as appropriate through documentation validation. Adhere to Prisma Health Coding and Compliance policies and procedures for assignment of complete, accurate, timely, and consistent codes; periodically code medical records. Essential Functions - Collaborates with Coding and Revenue leadership to develop and maintain coding curriculum, education, training, and other materials; train coders. - Works in conjunction with Coding leadership teams to develop annual Coding goals and objectives and audit calendar. - Works in conjunction with Coding leader to ensure continuous feedback and re-education if necessary; makes recommendations to the Coding Leadership Team when audits identify need for individualized focused audits. - Presents risk assessment of findings and develops, presents, and carries forward individualized educational plans to improve coder productivity and accuracy. - Performs quality assurance reviews to assess comprehension of training efforts. - Periodically codes all Inpatient visit types/records based on review of clinical documentation. Queries physician following established guidelines when existing documentation is unclear or ambiguous following American Health Information Management Association (AHIMA) guidelines and established policy. - Ensures all open queries initiated by Clinical Documentation Specialists have been addressed prior to final coding. Consults, provides professional expertise to, and collaborates with clinical documentation specialists on coding and documentation practices and standards. - Participates in a variety of committees and groups, acting as a representative of Health Information Management (HIM) and addressing documentation, data integrity, and other coding issues. - Reviews auditing medical records to identify trends coding issues, escalating identified concerns to coding leadership. - Participates in on-site, remote, and/or external training workshops and training. Attends and participates in CDI-Coding Task Force and other collaborative training and education with CDI, PFS, and Quality. - Demonstrates proficiency in utilizing official coding books as well as the electronic medical record, computer-assisted coding/encoding software, and clinical documentation information systems to facilitate coding assignment. - Adheres to department standards for productivity and accuracy. - Performs other duties as assigned. Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements - Education: Associate's degree or Coding Certificate through approved American Health Information Management (AHIMA) or other coding certification program. - Experience: Four (4) years of coding experience in an acute care or ambulatory setting. Work experience may NOT be substituted for education requirement; education and/or coder training experience preferred; inpatient and outpatient experience required. In Lieu Of NA Required Certifications, Registrations, Licenses - Registered Health Information Technician (RHIT) - Registered Health Information Administrator (RHIA) - Certified Coding Specialist (CCS) - Certified Inpatient Coder (CIC) - Other approved coding credential. Knowledge, Skills and Abilities - Knowledge of electronic medical records and 3M or Encoder System. - EPIC health information system experience. Preferred. - Strong knowledge of medical terminology and basic anatomy and physiology, pathophysiology, and pharmacology with the ability to apply this knowledge to the coding process. - Knowledge of MS DRG prospective payment system and severity systems. - Ability to concentrate for extended periods of time. - Ability to work and make decisions independently. Work Shift Day (United States of America) Location Corporate Facility 7001 Corporate Department 70017512 HIM-Coding Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.