Role Description A coder for Nexus Health Systems has the primary role of accurate coding and DRG assignment for all Nexus facilities. Under the System Director Health Information Management supervision, the coder will maintain professional certification while demonstrating a working knowledge of LTC MS-DRGs, APR-DRGs, ICD-9-CM, ICD-10-CM, and CPT coding requirements. The coder will be directly responsible for admission, concurrent and discharge coding, meeting the facility coding turnaround times, abstracting, coding query compliance, working with CDI to improve physician documentation and metrics utilization. This 100% remote corporate position is based out of Nexus Specialty Hospital. The position requires travel to the facility only for scheduled meetings and mandatory in-services. Qualifications - Completion of a 2 or 4 year accredited Health Information Management degree program preferred. - Minimum of 4 years experience with inpatient ICD-9-CM and PCS coding and CPT coding. Long Term Acute Care coding experience preferred. - Working knowledge of LTC-MS-DRGs, APR-DRG’s, coding query utilization, and documentation improvement practices. - ICD-10 Training completed. Dual coding experience preferred. - RHIA, RHIT, or CCS with certification maintenance. - Maintain current certification in good standing during employment with this facility, or obtain within thirty (30) days of hire. Requirements - Adheres to the turnaround times designated by Nexus for timely and accurately coding, timely communication of DRG assignment and updates, and claim creation for timely billing. - Responsible for assigning principal diagnosis within 24 hours of H&P completion, daily concurrent abstracting and review, and final DRG and code assignment within 72 hours of discharge. - Accurately abstracts and audits medical records for documentation compliance and accuracy to reflect accurate code assignment to support illness severity and service intensity. - Recognizes the role of a coder and how it relates to the overall clinical function of the hospital regarding correct documentation of patient care and fiscal reimbursement. - Identifies documentation improvement areas through admission, concurrent, and discharge abstracting and utilizes coding queries to meet specific coding guidelines. - Creation, implementation, and tracking of coding query compliance for physicians. - Plays an active role in the weekly DRG multi-disciplinary meetings to educate and gain clinical knowledge that can be utilized to optimize DRG assignment and documentation. - Accurately updates HIM Statistics related to admission, discharges, code assignment, final CMI, and LOS data. - Keeps track of LOAs and updates DRG spreadsheet daily. - Consistently demonstrates the ability to promptly recognize, establish, and deal with issues. - Strives to meet daily deadlines and demonstrates good time management skills, and participates in special projects and studies as assigned. - Maintain a 90% accuracy rate on coding audits performed monthly. Five percent of discharges will be audited monthly. - Assistance with RAC and third-party audit reviews related to coding and documentation issues. - Identifies and works towards resolutions of problems with charts or physicians that can cause delays with coding and/or clinical care. - Takes initiative to self-educate on the latest federal, state, and accreditation guidelines related to HIM and coding. - Actively uses coding clinic and latest coding guidelines and conventions for accurate code assignment. - Utilizes and completes all 3M education coding modules for ICD-10. - Works closely with the facility to ensure administration, case management, and the liaisons are aware of all coding changes and documentation barriers. - Attends coding round tables, meetings, and in-services as assigned. - Performs other duties as assigned. Benefits

Role Description BJC is hiring for an Outpatient Coder III. This is a remote position. No previous coding experience is required. Training will be provided. - Must have one of the following certifications: RHIA, RHIT, CCS, CPC, CPC-A, CCA, or COC - Eligible remote states: - Alabama - Arkansas - Florida - Georgia - Illinois - Indiana - Iowa - Kansas - Kentucky - Louisiana - Mississippi - Missouri - North Carolina - Ohio - Oklahoma - South Carolina - Tennessee - Texas - Wisconsin Qualifications - High School Diploma or GED - Cert/Lic in Area of Expertise Requirements - No Experience - No Supervisor Experience Preferred Requirements - 2-5 years of experience Benefits - Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date - Disability insurance paid for by BJC - Annual 4% BJC Automatic Retirement Contribution - 401(k) plan with BJC match - Tuition Assistance available on first day - BJC Institute for Learning and Development - Health Care and Dependent Care Flexible Spending Accounts - Paid Time Off benefit combines vacation, sick days, holidays and personal time - Adoption assistance

• Submit accurate insurance claims via SimplePractice, verifying CPT codes, diagnosis codes, payer IDs, and fees prior to submission; monitor claim status on a bi-monthly cadence and process resubmissions, reconsiderations, and appeals as needed. • Generate and send invoices for deductibles, coinsurance, no-show fees, and private pay balances; follow up with patients on outstanding amounts and manage accounts escalated to collections per company policy. • Verify patient benefits including deductibles, coinsurance, and visit limits prior to billing; identify and communicate insurance red flags, ensure required agreements are signed, and track deductible accumulation. • Review EOBs to confirm payment accuracy, match payments to dates of service, and identify discrepancies; reconcile insurance payments against internal records and investigate mismatches or missing payments. • Identify cases where insurance payments are sent directly to patients and initiate follow-up via portal, SMS, or email to collect and apply outstanding payments; escalate unresolved cases as needed. • Maintain Admin Notes in SimplePractice, Trello tracking cards, and internal spreadsheets for audit readiness; manage pre-authorizations, pre-certifications, and auto accident workflows; communicate clearly with patients on coverage, billing responsibilities, and payment expectations.

Role Description Medical Records Technician (Coder - Outpatient and Inpatient) analyzes and abstracts patients' health records and assigns alpha-numeric codes for each diagnosis and procedure. To perform this task, he/she must possess expertise in International Classification of Diseases (ICD), Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS). - This position is in the Health Information Management Service (HIMS) at the VA Western New York Health Care System (VAWNYHCS). - MRTs (Coder) are skilled in classifying medical data from patient health records in the hospital setting, and/or physician-based settings. GS-4 - Applies knowledge of medical record content, medical terminology, anatomy & physiology, diseases processes, and official coding guidelines to assign codes to the most basic and routine outpatient and inpatient services. - Selects and assigns codes from the current versions of the International Classification of Diseases (ICD) Clinical Modification (CM) and Procedure Coding System (PCS) for inpatient facility MS-DRG coding, and Current Procedural Terminology (CPT), and/or Healthcare Common Procedure Coding System (HCPCS) for inpatient professional coding and outpatient coding. - Incumbent with instruction from a senior coder or supervisor learns to select diagnosis, operation, or procedure codes based on the accepted coding practices, guidelines, conventions and policy. GS-5 - Establishes the primary and secondary diagnosis and procedure codes for billable outpatient encounters for one specialty or subspecialty following applicable regulations, instructions, and requirements for allowable reimbursement. - Links the appropriate diagnosis to the procedure and/or determines level of E/M service provided. - Uses basic knowledge of the CPT and HCPCS coding systems for Third Party Insurance cost recovery. - Codes less complex Operating Room procedures reported in the Surgical Package of the VistA hospital system. - Updates ICD diagnosis and procedure codes for the quarterly inpatient and Contract Nursing Home census for assigned inpatient admissions. - Applies ICD and CPT coding systems and guidelines and selects proper codes using the current code set and the encoder product suite. - Incumbent updates any assigned billable long stay (30+ days) inpatient admissions to reflect all patient conditions and care up for monthly billing. GS-6 - Assigns codes to documented patient care encounters (inpatient and outpatient) for one or more specialty and subspecialty health care services provided by the VAMC. - Incumbent has knowledge of medical terminology, anatomy & physiology, diseases, treatments, diagnostic tests, and medications to ensure proper code selection. - Incumbent selects and assigns codes from the current version of one or more coding systems depending on regular/recurring duties. - Incumbent monitors ever-changing regulatory and policy requirements affecting coded information for the full spectrum of services provided by the VAMC. - Uses skill and knowledge of the organization and structure of the patient health record to capture and justify code assignment. - Incumbent at the direction of the supervisor assists in orienting and instructing new personnel and/or students from affiliated health information or medical record technology programs. GS-7 - Receives minimal monitoring. MRTs (Coder) perform a combination of inpatient and outpatient coding duties. - Selects and assigns codes from current versions of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS classification systems to both inpatient and outpatient records. - Incumbent adheres to accepted coding practices, guidelines and conventions when choosing the most appropriate diagnosis, operation, procedure, ancillary, or evaluation and management (E/M) code to ensure ethical, accurate, and complete coding. - Performs a comprehensive review of the patient health record to abstract medical, surgical, ancillary, demographic, social, and administrative data to ensure complete data capture. - Incumbent expertly searches the patient health record to find documentation justifying code assignment based on an expanded knowledge of the organization and structure of the patient record. GS-8 - Incumbent is at the journey level for this assignment. MRTs (Coder) at this level perform the full scope of inpatient and outpatient coding duties. - MRTs (Coder) select and assign codes from current versions of ICD-10-CM, ICD-10-PCS, CPT, and HCPCS classification systems to both inpatient and outpatient records. - Directly consults with the clinical staff for clarification of conflicting, incomplete, or ambiguous clinical data in the health record. - Independently plans and executes tasks related to medical record coding and documentation. - Incumbent expertly searches the patient health record to find documentation justifying code assignment based on an expanded knowledge of the organization and structure of the patient record. Qualifications - United States Citizenship: Non-citizens may only be appointed when it is not possible to recruit qualified citizens in accordance with VA Policy. - One year of creditable experience that indicates knowledge of medical terminology, anatomy, physiology, pathophysiology, medical coding, and the structure and format of health records. - Education: An associate's degree from an accredited college or university recognized by the U.S. Department of Education with a major field of study in health information technology/health information management, or a related degree with a minimum of 12 semester hours in health information technology/health information management. - Completion of an AHIMA approved coding program, or other intense coding training program of approximately one year or more that included courses in anatomy and physiology, medical terminology, basic ICD diagnostic/procedural, and basic CPT coding. - Equivalent combinations of creditable experience and education are qualifying for meeting the basic requirements. Requirements - Certification: Persons hired or reassigned to MRT (Coder) positions in the GS-0675 series in VHA must have either: - Apprentice/Associate Level Certification through AHIMA or AAPC. - Mastery Level Certification through AHIMA or AAPC. - Clinical Documentation Improvement Certification through AHIMA or ACDIS. - Applicants pending the completion of educational or certification/licensure requirements may be referred and tentatively selected but may not be hired until all requirements are met. Benefits - Not specified in the provided job description. Company Description - Not specified in the provided job description.