Review system-generated coding edits (e.g., CCI, LCD/NCD, MUE, medical necessity, modifier edits) and determine appropriate corrective actions. - Analyze documentation to validate ICD-10-CM, CPT, and HCPCS assignments and ensure compliance with official coding guidelines. - Collaborate with coding staff to resolve complex edit issues and escalate patterns or system-related problems as needed. Abstracts clinical information from a variety of medical records, charts and documents and assigns appropriate ICD-10 and/or CPT-4 codes to patient records according to established procedures. Works with coding databases and confirms CPT codes. Inputs and maintains data on procedures required for state or other reporting. May require an associate degree. Requires a certification from AAPC Certified Professional Coder (CPC) or AHIMA RHIT or CCS. Works with the coding manager and team on this site. Has attained full proficiency in multiple specialties of discipline. Typically requires 4+ years of related OBS/OPS coding experience, and may include additional credentials. Performs coding on multiple specialties with proficiency. Business Support

The Billing & Posting Resolution Provider position is responsible for acting as a liaison for hospitals and clinics using TruBridge’s complete business office services. They work closely with TruBridge management and hospital employees to bill insurance companies for all hospital, hospital-based physician and clinic bills. They pursue collection of all claims until payment is made by insurance companies; and perform other work associated with the billing process. These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required. Goals and objectives are subject to change. All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Prepares and submits hospital, hospital-based physician and clinic claims to third-party insurance carriers either electronically or by hard copy billing. - Secures needed medical documentation required or requested by third party insurances. - Follows up with third-party insurance carriers on unpaid claims till claims are paid or only self-pay balance remains. - Processes rejections by either making accounts private or correcting any billing error and resubmitting claims to third-party insurance carriers. - Responsible for consistently meeting production and quality assurance standards. - Maintains quality customer service by following company policies and procedures as well as policies and procedures specific to each customer. - Updates job knowledge by participating in company offered education opportunities. - Protects customer information by keeping all information confidential. - Processes miscellaneous paperwork. - Ability to work with high profile customers with difficult processes. - May regularly be asked to help with team projects. - Ensure all claims are submitted daily with a goal of zero errors. - Timely follow up on insurance claim status. - Reading and interpreting an EOB (Explanation of Benefits). - Respond to inquiries by insurance companies. - Denial Management. - Meet with Billing Manager/Supervisor to discuss and resolve reimbursement issues or billing obstacles. - Review late charge reports and file corrected claims or write off charges as per client policy. - Review reports identifying readmissions or overlapping service dates and ignore, merge, or split-bill according to the payer’s rules and the client’s policy. - Review credit reports, resolve credits belonging to a payer when able, and submit a listing of credits to the facility as required by the payer. Minimum Requirements: Education/Experience/Certification Requirements - - UB and 1500 billing Medicare DDE required - Computer skills. - Experience in CPT and ICD-10 coding. - Familiarity with medical terminology. - Ability to communicate with various insurance payers. - Experience in filing claim appeals with insurance companies to ensure maximum reimbursement. - Responsible use of confidential information. - Strong written and verbal skills. - Ability to multi-task.

The Coding Advocate will handle medical coding and data entry / abstraction for various types of Hospital visits: Inpatient, Outpatient, Ambulatory, Surgery, Emergency and Special Procedures. These Goals and objectives are not to be construed as a complete statement of all duties performed; employees will be required to perform other job related duties as required. Goals and objectives are subject to change. All activities must be in compliance with Equal Employment Opportunity laws, HIPAA, ERISA and other regulations, as appropriate. Essential Functions: In addition to working as prescribed in our Performance Factors specific responsibilities of this role include: - Inpatient: Accurately assigns ICD-10-CM and PCS primary and secondary diagnoses and procedure codes based on the documentation in the record and in accordance with the site specific guidelines and policies. Accurate assignment of the DRG. - Outpatient: Correctly assigns modifiers to chargemaster items and coder assigned CPT codes as applicable to outpatient coding, as appropriate. - Outpatient Surgery: Correctly assigns CPT codes to outpatient procedures consistent with client contract and documentation in the record. - Emergency Room: Correctly assign diagnosis codes, assign appropriate E&M facility and/or profee levels, assign infusion and injection CPT codes. - Ability to create compliant physician queries. - Accurately review claims for medical necessity. - Update problem lists consistent with client contract. - Correctly assign present on admission indicators. - Ability to provide excellent customer service to our clients and teammates. - Consistently demonstrates an excellent attitude, and works to strengthen the team as a whole. - Floats between multiple sites, and coding specialties with ease and flexibility. Minimum Requirements: Education/Experience/Certification Requirements - 2 year degree or equivalent experience; AHIMA or AAPC certification required - Actively holds one or more of the following credentials: RHIA, RHIT, CCS, CPC, COC - Minimum of 1 year experience coding inpatient/facility - CABG/Heart Cath accounts - Meets or exceeds Quality and Productivity standards. - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently, and as a team member. - Excellent communication (written and oral) and interpersonal skills. - Strong organizational, multi-tasking, and time-management skills. - Must be detail oriented and able to follow through on issues to resolution. - Must be able to act both independently and as a team member. Preferred Qualifications: - 2+ years of coding experience in multiple patient types - Experience coding and charging injections and infusions Business Support

Description: Could you be our next Ambulatory Telecare Nurse at Main Line Health? Position: Ambulatory TeleCare Nurse. You must live within 2 hours of Main Line Health locations to be considered for this position. Department orientation is on site for 5-6 weeks. Shift: Remote position (Monday through Friday-40 hours per week) No weekends or holidays. Why work as a TeleCare Nurse? - Make an Impact! As a TeleCare Nurse, you will part of a Remote patient Triaging team that supports general care processes to patients in the Primary Care Ambulatory Practices within the Main Line HealthCare System. You will be responsible for evaluating and assessing the health care needs of patients based on telephonic evaluation of patient-reported signs and symptoms. This important role delivers, manages, and coordinates care and services within the domain of Ambulatory Care Nursing and ensures continuity of care through communication with other members of the patient’s health care team. - Develop and Grow your Career! Invest in furthering your education through seeking certifications or advanced degrees by taking advantage of our Tuition Reimbursement! This position is eligible for up to $6,000 per year based upon your Full or Part Time status. - Get Involved! Become engaged by joining hospital & system-wide Nursing Committees, Unit Councils, evidence-based research projects, precepting new staff, and pursuing the Clinical Ladder program. - Join the Team! Like our patients, the Main Line Health Family encompasses a wide range of backgrounds and abilities. Just as each of our patients requires a personalized care plan, each of our employees, physicians, and volunteers, bring distinctive talents to Main Line Health. Regardless of our unique design, we all share a common purpose: providing superior service and care. - Position-Specific Benefits include: You are eligible for up to 160 hours of paid time off per year based on your Full or Part Time status. We also offer a number of employee discounts to various activities, services, and vendors... And employee parking is always free! Position: Ambulatory TeleCare Nurse. You must live within 2 hours of Main Line Health locations to be considered for this position. Department orientation is on site for 5-6 weeks. Shift: Remote position (Monday through Friday-40 hours per week) No weekends or holidays. Experience: 1. Minimum of 3 years recent clinical experience in critical care, emergency department, home health, or physician practice nursing is required. 2. Telephone triage experience of at least 1 year is strongly preferred. Education: 1. Associates Degree Required - Graduation from an accredited School of Nursing required. 2. BSN strongly preferred. Licensures/Certifications: 1. PA RN license OR a multi-state license verified in one of the approved states through the Nursing Licensure Compact. 2. Provider BLS (American Heart Assoc/American Red Cross) required.