• You will be introduced to health insurance, multiple healthcare settings, coding, and reimbursement. • You will become familiar with the health insurance industry, legal and regulatory issues, differences in reimbursement methodologies, and the principles of medical billing related to proper claim form preparation, submission and payment processing, and the follow-up process. • Provide efficient and effective coding services on behalf of our member clients in accordance with Payer requirements and organizational policies, while ensuring compliance to all coding guidelines. • Review and interpret patient encounters for accurate code assignment of all relevant diagnoses and procedures. • Help fulfill the reimbursement needs of the member through review and recommendation or correct assignment of diagnosis and procedure codes which are critical to third party reimbursement. • Research and obtain necessary information from provider/office via Epic in-basket when necessary, per agreement. • Assist with research for denied claims. • Meet assigned productivity goals. • Establish and maintain positive working relationships with patients, payers, team members, clients and other stakeholders. • Maintain confidentiality of patient information, organization data and information, and in compliance with HIPAA regulations.

• Participants develop an understanding of how healthcare services are documented, coded, credentialed, enrolled with insurance payers, and reimbursed within healthcare organizations. • Learners gain foundational knowledge of the three primary healthcare code sets used in medical billing and coding: CPT, ICD-10-CM, HCPCS Level II. • Throughout the program, learners are introduced to the processes involved in provider credentialing and recredentialing, payer enrollment, and documentation verification.

Title: Inpatient Senior Coder Location: Centralized Revenue Cycle, Lake Success, NY Requisition : 169415 Profession : Revenue Cycle Specialty: Coding Full Time, Days, 7:00 AM-7:00 PM Salary Range: $66220.05-$108179.96/year Job Description: Remote Work Schedule: Sun-Thurs or Tues-Sat flexible hours between 7am-7pm $5k Sign on Bonus eligible Job Description Performs coding and abstracting duties to assure accurate completion of coding for all assigned patient records. Job Responsibility 1.Analyzes and interprets the medical record in its entirety to ensure accurate, complete and consistent selection of diagnoses and procedures to assure the production of quality healthcare data and accurate facility payment. 2.Applies understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable codes. 3.Utilizes resources and reference materials (e.g., manuals, online resources: Official Coding Guidelines (OCG), AHA Coding Clinic, Center for Medicare Services and CPT Assistant) to identify appropriate codes and reference code applicability, rules and guidelines. 4.Applies the Uniform Hospital Discharge Data Set (UHDDS) definitions as well as any additional regulatory guidelines and/ or coding references to select the principal diagnosis, secondary diagnoses, all significant procedures, indicating the patient's acuity, severity of illness and risk of mortality (if applicable), as documented in the medical record. 5.Codes and reports diagnoses and their associated present on Admission (POA) Indicator and procedures. 6.Accurately assigns discharge disposition for all records as required and in accordance with the Centers for Medicare and Medicaid Services (CMS) rules and regulations. 7.Make determinations on medical coding and takes initiative to complete reviews and coding independently, to avoid delays in the workflow process. 8.Manages multiple work demands simultaneously to maintain relevant efficiency and turnaround time standards for completing coding/DRG assignment. 9.Assigns and reports all other data elements required for Statewide Planning and Research Cooperative System (SPARCS) data collection, Congenital Malformations and Expirations. 10.For outpatient encounters, applies coding conventions and official coding guidelines approved by the Current Procedural Terminology (CPT) rules established by the American Medical Association (AMA), and any other official rules and guidelines established for use with the mandated outpatient procedure code sets. 11.Assigns appropriate discharge physician in the system. 12.Generates compliant physician queries to clarify any incomplete/ambiguous or conflicting documentation and applies post-query responses to make final coding determinations. 13.Demonstrates basic knowledge of the impact of coding decisions on revenue cycle. 14.Assists in the education of physicians and other clinicians by advocating proper documentation practices, further specificity, resequencing and inclusion of diagnoses or procedures when needed to more accurately reflect the acuity, severity of illness and risk of mortality as indicated. 15.Attends and participates in required hospital education programs in order to maintain and enhance their coding skills and stay abreast of changes in codes, coding guidelines and regulations. 16.Completes moderately complex assignments that require an ability to recognize the need to occasionally deviate from accepted practices. 17.Exercises independent judgment on basic or moderately complex issues regarding job and related tasks. 18.Works independently under minimal supervision within established guidelines and procedures. 19.Requires minimal instruction on day-to-day work; majority of work is self-directed; receives instruction on new assignments. 20.Works with lead on resolution of day-to-day technical/procedural challenges. 21.May provide work guidance to team members to ensure accurate and timely completion of tasks. 22.Performs related duties, as required. - ADA Essential Functions Job Qualification - High School Diploma or equivalent required. - 3 - 5 years of technical experience, required. - One or more of the following required: Certified Coding Specialist (CCS) or Certified Professional Coder (CPC) or Certified Coding Specialist-Physician (CCSP) or Certified Inpatient Coder (CIC) or Certified Outpatient Coder (COC) or RHIA or RHIT certification. - Inpatient facility coding experience, preferred. - Additional Salary Detail The salary range and/or hourly rate listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining a team member's base salary and/or rate, several factors may be considered as applicable (e.g., location, specialty, service line, years of relevant experience, education, credentials, negotiated contracts, budget and internal equity).

Title: Revenue Cycle Billing Specialist - FT - Day - MSO/Centralized Billing Remote NJ Location: Telecommuters Job Description: Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $19.32 - $24.13 Scheduled Weekly Hours: 40 Position Overview Responsible for all aspects of claim submission for services rendered at Capital Health through the Revenue Cycle life cycle to all payers, including but not limited to pre and post claim review, claim (277) rejections, denial review, and claim resubmission. Provides, elicits, and gathers information to facilitate, expedite, and obtain professional payments from third party carriers. Performs collection and follow-up activity with insurance companies. Completes necessary billing projects as assigned. Meets internal and external customer expectations. MINIMUM REQUIREMENTS Education:    High school diploma or equivalent. Experience:    One year' previous healthcare billing experience in a hospital, professional, or medical office setting. Other Credentials:     Knowledge and Skills:     Special Training:    Working knowledge of Microsoft office and excel. Experience using Electronic Medical Record (EMR) software. Cerner, Athena, Epic preferred. Mental, Behavioral and Emotional Abilities:    Can work well independently and in team settings. Usual Work Day:    8 Hours   Reporting Relationships Does this position formally supervise employees? No If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager. ESSENTIAL FUNCTIONS Responsible for all primary and secondary claims submitted to payers according to insurance requirements. Analyzes claims for errors during all stages of submission for accuracy of billing. Maintains current knowledge of payer requirements Demonstrates comprehensive understanding of team functions and specialized terminology of third-party payers. Works closely with appropriate staff/departments to make corrections and ensures accuracy for the days’ work (ex: coding and patient access: CCI edits, Medical Unlikely edits, demographic information, date of birth, etc). Resolves all Return to Provider (RTP) claims in error in the Medicare Fiscal Intermediary Shared System (FISS) on a daily basis (hospital only). Resolves New Jersey Discharge Data Collection System (NJDDCS) MIDS errors on a routine basis as defined by management (hospital only). Verifies covered days (hospital) and services to be rendered (hospital/professional) prior to submitting claims in a timely manner. Corrects errors from the daily claim (277) rejections or escalates to the appropriate department for resolution. Reviews hospital billing reports for corrections needed in order to have the accounts final bill – these includes but are not limited to: Late Charge report, 72-hour report, etc. to ensure claims are billed timely and accurately (hospital only). Evaluates, reviews, and analyzes patient accounts to determine if third party payments have been received, recorded, and are appropriate based on contractual expectations. Review patient’s account in totality, including demographic information, service rendered, insurances documentation, etc to gain full understanding of the patient’s A/R. Performs appropriate follow-up which could include calls to payers, claim review on payer portal, manual adjustment to account balance and financial class changes, where relevant. Answers calls and other inquiries from payer representative timely regarding accounts and completes proper documentation of all activity on each account. Identifies and communicates payment variances, error trends, and account issues for resolution to management. Identifies denial trends and reports them to management to allow for more efficient billing and timely resolution. Reviews credit balances for adjustments, refund and/or claim adjustment submission as assigned. Researches and retrieves appropriate documentation (e.g. authorizations, medical records) for appealing denials. Works correspondence as assigned and escalated by correspondence team. Communicates denials and other issues with the appropriate Revenue Cycle department and/or physician representative to address root causes. Documents clear and concise notes in the billing system. Operates other relevant computer software efficiently to complete required billing and follow-up tasks. Enters charges into Billing System from various reports, where relevant. Performs assigned worklists and other duties quickly and accurately showing attention to details and is sufficiently organized to produce quality work. Maintains assigned productivity standards and escalates obstacles in accomplishing expectations in a timely manner. Prioritizes and updates files and other required documentation in accordance with established policies, guidelines, and procedures. Demonstrates willingness to adapt to changing departmental demands as new billing duties are required. Completes special assignments and projects with minimal supervision and consistently meets targets. Performs other duties as assigned and adapts to changing departmental demands. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Standing , Walking , Talk or Hear Occasional physical demands include: Climbing (e.g., stairs or ladders) , Carry objects , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation Continuous physical demands include: Sitting , Pinching/fine motor activities , Keyboard use/repetitive motion Lifting Floor to Waist 20 lbs. Lifting Waist Level and Above 10 lbs. Sensory Requirements include: Very Accurate 20/40, Near Vision, Accurate Far Vision, Color Discrimination, Minimal Depth Perception, Minimal Hearing Anticipated Occupational Exposure Risks Include the following: N/A This position is eligible for the following benefits: - Medical Plan - Prescription drug coverage & In-House Employee Pharmacy - Dental Plan - Vision Plan - Flexible Spending Account (FSA) - Healthcare FSA - Dependent Care FSA - Retirement Savings and Investment Plan - Basic Group Term Life and Accidental Death & Dismemberment (AD&D) Insurance - Supplemental Group Term Life & Accidental Death & Dismemberment Insurance - Disability Benefits – Long Term Disability (LTD) - Disability Benefits – Short Term Disability (STD) - Employee Assistance Program - Commuter Transit - Commuter Parking - Supplemental Life Insurance - Voluntary Life Spouse - Voluntary Life Employee - Voluntary Life Child - Voluntary Legal Services - Voluntary Accident, Critical Illness and Hospital Indemnity Insurance - Voluntary Identity Theft Insurance - Voluntary Pet Insurance - Paid Time-Off Program The pay range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. When determining base salary and/or rate, several factors may be considered including, but not limited to location, years of relevant experience, education, credentials, negotiated contracts, budget, market data, and internal equity. Bonus and/or incentive eligibility are determined by role and level.  The salary applies specifically to the position being advertised and does not include potential bonuses, incentive compensation, differential pay or other forms of compensation, compensation allowance, or benefits health or welfare. Actual total compensation may vary based on factors such as experience, skills, qualifications, and other relevant criteria.