• 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

• Reviews medical record documentation to determine appropriate billing codes • Codes evaluation and management to appropriate CPT code • Codes diagnosis to appropriate ICD-9 code • Meets with physicians to review documentation and tags files for follow up • Assists coders with medical terminology and policy interpretation

• Reviewing and accurately coding all professional services including evaluation and management, diagnostics, surgeries, and procedures in compliance with applicable Medicare, Medicaid, and third-party payer guidelines to ensure receipt of accurate reimbursement. • Prioritizing daily duties and multitasking effectively. • Communicating with leadership on coding or documentation issues/trends. • Staying current on all coding guidelines (including specialty-specific guidelines) and maintaining credentials as necessary. • Participating in coding department and education meetings. • Maintaining confidentiality and protecting sensitive information. • Other duties as assigned by leadership.

• Code for Multispecialty Surgery physicians primarily Single Path Coding • Accurately code conditions and procedures as documented and in accordance with ICD-10-CM Official Guidelines for Coding and Reporting • Maintain a working knowledge of ICD-10 and CPT coding principles • Assures that all services documented in the patient’s chart are coded with appropriate ICD-10 and CPT codes • Achieves and maintains 97% accuracy in coding while maintaining a high level of productivity • Works the review queue daily to ensure all charts that are placed in the review queue are worked