• Ensures the timely and accurate coding and completion of patient accounts within established departmental accuracy and productivity standards. • Applies correct ICD CM/PCS (Inpatient) and ICD CM/CPT codes (Outpatient) guidelines meeting departmental policy regarding compliant methods, timeframes, use of applications and productivity. • Assists in demonstrating medical necessity for procedures performed by ensuring that all documented disease processes are coded. • 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 code assignment. • Reviews facility charges as provided and edits where necessary to ensure charges are compliant and substantiated by provider documentation. • May require frequent and close collaboration with multiple areas of the organization including providers, Professional Coding, and Finance for audit and problem-solving activities. • Demonstrates full understanding and is compliant with correct coding initiative guidelines, regulatory requirements regarding coding of medical information including but not limited to external regulatory agencies such as Quality Improvement Organizations (QIOs), the Centers for Medicare & Medicaid Services (CMS) and other payers, and the Joint Commission. • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association (AHIMA) and adheres to official coding guidelines. • Queries physician when existing documentation is unclear or ambiguous following AHIMA guidelines and established policy. • Brings identified concerns to Manager Coding for resolution. • Assigns the MS DRG and MCC/CCs that most appropriately reflect documentation of the occurrence of events, severity of illness, and resources utilized during the inpatient encounter and in compliance with department (Inpatient). • Reviews department-specified reports daily to identify charts that need to be coded and prioritizes as per department-specific guidelines and within designated timelines. • Follows up to ensure that any edits that prevent an account from dropping are corrected within established timelines. • Produces specific reports on a monthly basis per established parameters. • Responds to inquiries from Patient Accounts or other departments as requested. • Communicates with Manager when trending request volumes impact productivity. • Demonstrates continuous learning as evidenced by personally developed reference materials, online publications etc., to stay abreast of new and revised guidelines, practices and terminology, for reference and application. • Participates in on site and/or external training workshops as opportunities arise. • Maintains credentials, if applicable, and submits written evidence of maintenance. • Participates in training other coders and acts as a mentor, when assigned. • Collaborates on cases where the final DRG and coded DRG differ, in order to resolve the difference (Inpatient). • Works with the Health Records Specialists to identify opportunities for MS-DRG optimization when medically indicated (Inpatient). • Participates in accurate data collection, evaluation and recommendations for process improvements. • Participates as a member of the Clinical Documentation Management Program. • Functions as an organizational coding expert, and additionally supports the Managers of Coding Quality and Integrity Review in auditing and training and re-training of coders as directed. • Special duties and projects may additionally be assigned in support of the department goals.

• Focus heavily on Charge Processing while also executing a variety of medical billing and revenue cycle workflows. • Process daily/weekly/monthly billing tasks to ensure optimal and accurate revenue collection. • Work with charges, transactions, AR management, patient and payer calls, and online payer portals. • Review and research federal, state, and payer billing requirements. • Collaborate with internal teams to support our member organizations and deliver high‑quality service. • Participate in training and maintain up‑to‑date knowledge of coding, billing rules, and healthcare regulations. • Use NextGen PM to support accurate billing and documentation processes. • Contribute to workflow analysis and best‑practice recommendations. • Meet attainable performance goals in accuracy, productivity, and turnaround times.

• Focus heavily on payment posting while also executing a variety of medical billing and revenue cycle workflows. • Process daily/weekly/monthly billing tasks to ensure optimal and accurate revenue collection. • Work with charges, transactions, AR management, patient and payer calls, and online payer portals. • Review and research federal, state, and payer billing requirements. • Collaborate with internal teams to support our member organizations and deliver high-quality service. • Participate in training and maintain up-to-date knowledge of coding, billing rules, and healthcare regulations. • Use NextGen PM to support accurate billing and documentation processes. • Contribute to workflow analysis and best-practice recommendations. • Meet attainable performance goals in accuracy, productivity, and turnaround times.

• Responsible for making claim payments decisions on a wide variety of claims within department standards • Responsible for researching, analyzing, and making payment decisions on moderately complicated claims based on medical coding guidelines and policies • Refer suspected Fraud, Waste, or Abuse to the SIU when identified in normal course of business • Acts as a technical resource to new associates by reviewing claims, training staff, responding to claim questions • Responsible for identifying and implementing process improvements and referring system enhancement ideas to manager • Collaborates with internal departments to facilitate claim processing and to come to appropriate claim resolutions • Responds to claim questions and concerns • Prepares claims for Medical Director review by completing required documentation and ensuring all pertinent medical information is attached as needed • Ensure adherence to all company and departmental policies and standards for timeliness of review and release of claims • Responsible for identifying systemic claim problems/concerns and reporting them to management • Responsible for supporting provider pre-pay and post-pay teams with coding reviews and clinical documentation reviews • Provide support for provider appeals to denied claims