Role Description As a Medical Coder, you will ensure precise communication with insurance companies so that services are documented correctly and payments are processed efficiently. Every day you will accurately translate patients’ medical records into standardized codes for diagnoses and treatments. Using your expertise and training, you will ensure compliance with legal, regulatory, and organizational standards. To be successful in this role, you must combine accuracy and attention to detail with a strong knowledge of coding standards and healthcare regulations. Clear communication with providers and staff, along with efficient management of records, ensures claims are processed correctly and on time. - Applies a thorough understanding/interpretation of Explanation of Benefits (EOBs) and remittance advices, including when and how to ensure that correct and appropriate payment has been received. - Communicates effectively over the phone and through written correspondence to explain why a balance is outstanding, denied and/or underpaid using accurate and supported reasoning based on EOBs, reimbursement, and payer specific requirements. - Reviews patient medical record to compare documentation and coding; changes coding based on documentation to include diagnosis codes, modifiers, place of service, etc. - Communicates with provider to resolve claims that require a written appeal or second level appeal. - Resubmits claims with necessary information when requested through paper or electronic methods. - Anticipates potential areas of concern within the follow-up function; identifies issues/trends and conducts staff training to address and rectify. - Recognizes when additional assistance is needed to resolve insurance balances and escalates appropriately and timely through defined communication and escalation channels. Qualifications - High School Graduate General Studies and 1+ years coding experience, upon hire - High School GED General Studies and 1+ years coding experience, upon hire - Associates in related field and Insurance follow up experience, upon hire - Completion of college level courses in medical terminology, anatomy and physiology, disease processes and pharmacology, upon hire - Completion of ICD-10 or CPT coding course, upon hire - Certified Professional Coder, upon hire - Certified Professional Coder Hospital Apprentice, upon hire - Certified Professional Coder Apprentice, upon hire - Certified Coding Associate, upon hire - Cardiology Coding, upon hire - Certified Coding Specialist, upon hire - Certified Coding Specialist - Physician Based, upon hire - Certified Cardiovascular and Thoracic Surgery Coder, upon hire - Certified Health Care Compliance, upon hire - Certified Interventional Radiology Cardio Coder, upon hire - Certified Professional Coder Hospital, upon hire - Radiology Certified Coder, upon hire - Registered Health Information Administrator, upon hire - Registered Health Information Technician, upon hire

Role Description Reviews inpatient records to identify the diagnosis and procedure codes performed during the patients stay are valid and in accordance with coding conventions and guidelines. Works on routine assignments within defined parameters, established guidelines and precedents. Follows established procedures and receives daily instructions on work. Qualifications - High School Education/GED or equivalent: Required - Working knowledge of hospital Cerner EMR (electronic medical record) and of ICD-10-CM and ICD-10-PCS Codes: Required - Five years' inpatient coding experience: Required - Experience in a health care setting: Required - AHIMA Certified Coding Specialist (CCS): Required Requirements - Reviews MS-DRG, APR-DRG and payor denials and provides feedback to leadership and other departments including patient financial services and quality. - Performs inpatient audits including payor audits, discharge disposition audits and overall coding accuracy audits. - Maintains denial and other spreadsheets for assigned denial and audit duties. - Attends mortality meetings and provides coding feedback. - Provides input and feedback to clinical documentation integrity and quality departments for DRG mismatches. - Researches and provides feedback and direction to inpatient coding associates. - Ensures coding corrections and edits are updated. - Keeps abreast of regulatory changes related to coding and documentation and communicates these updates and changes to coding and leadership. - Provides educational sessions and training resources to coding associates. - Assists leadership and coding with reaching departmental metric goals. - Abstracts and assigns ICD-10-CM diagnosis codes and PCS codes from the inpatient patient record to ensure accurate MS-DRG and APR-DRG assignment and to provide information required for reimbursement and statistical data submissions. - Understands MS-DRG and APR-DRG methodologies. - Generates compliant physician queries. - Works with clinical documentation integrity and quality departments to identify HAC/PSI and communicate issues affecting inpatient records. - Validates appropriate dates of service against documentation in the EMR for inpatient encounters. - Completes required abstract fields in registration conversation on inpatient encounters for OSHPD and other data submissions. - Communicates with appropriate departments related to charge corrections/modifications. - Audits medical records to ensure proper coding is completed and to ensure compliance with federal and state regulatory agencies. - Follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies. - Reviews, understands and applies quarterly coding clinics, coding guidelines and coding conventions of ICD-10-CM references. - Collaborates to provide coding feedback and education to departmental leadership regarding completeness and accuracy of documentation and physician coding practices. - Analyzes content of reports and software edits to facilitate revisions with appropriate departments - NCCI edits. - Follows up coding holds, revenue cycle department holds including related and all other email communication. - Maintains required online Healthstream education courses. - Attends meetings and training pertaining to coder education, audit reviews, staff meetings, and inpatient coder roundtable meetings. - Performs other job-related duties as assigned. Benefits - Adventist Health is committed to the safety and wellbeing of our associates and patients. - All associates are required to receive all required vaccinations as a condition of employment and annually thereafter, where applicable. - Medical and religious exemptions may apply. - Adventist Health participates in E-Verify.

• Responsible for coding and abstracting inpatient accounts in accordance with coding guidelines. • Assigns accurate diagnostic and procedure codes according to clinical documentation and official coding guidelines for inpatient hospital accounts. • Coordinates with the clinical documentation and quality teams to ensure validation of Medicare Severity Diagnosis Related Group (MSDRG), patient safety indicators, and hospital acquired conditions are supported by physician documentation to support appropriate coding. • Monitors assigned work queues to ensure all records are charged in a timely matter. • Generates coding queries for clarification regarding physician documentation as needed. • Stays abreast of all changes in coding conventions and coding updates. • Performs other duties as assigned.

• Coding Specialists are an important part of the Team at CorroHealth. • Provide various components of coding services to support our clients. • Code surgical procedures typical of an ER setting to capture additional revenue when appropriate. • Apply ICD-10-CM diagnosis codes to the highest level of specificity available. • Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, ICD-10-PCS, CPT®, and HCPCS. • Interpret coding guidelines for accurate code assignment. • Actively participate in Company provided training and education.