• Code and audit outpatient encounters, ensuring code selection is supported by the documentation • Flag encounters where the documentation doesn't support the billed level • Escalate complex or ambiguous scenarios and document the reasoning so our guidelines improve over time • Give feedback on our automated coding logic — surface edge cases, false positives, and gaps the platform should handle • Contribute to internal QA, calibration sessions, training materials, and coding playbooks as the program scales

• Provide accurate and timely revenue cycle and account management services to OBS member clients. • Contribute to OCHIN’s key performance indicators by identifying and resolving claims issues. • Maintain compliance with payer requirements. • Engage in continuous process improvement. • Manage self-pay accounts and customer inquiries. • Handle daily claims production including printing, mailing, and preparing documentation for clean claim submission.

• Codes and abstracts professional fee hospital services performed by SLPG physicians from medical records according to ICD-9/ICD-10, CPT-4, HCPCS II, and CMS guidelines. • Utilizes 3M Encoder for validation of RVUs and CPT-4 procedure unbundling. • Maintains a 95% coding accuracy rate as measured through quality reviews. • Performs data entry of abstracted physician information into specialty-specific databases. • Conducts educational sessions to the medical staff for coding and documentation compliance.

Title: Outpatient Coder I Location: US, FL Job Description: Summary HIM Outpatient Coder 1 is responsible for coding and abstracting outpatient medical records, including Emergency Room visits, Clinic visits and Recurrent visits. The Coder 1 is responsible for reviewing the clinical documentation contained in the patient health record to accurately assign and sequence ICD-9 and CPT codes for use in reimbursement and data collection. Able to transition to ICD-10-CM. Responsibilities - Codes outpatient diagnostics/outpatient clinics/recurring visits/emergency room visits using ICD-9 or CPT codes as appropriate. - Maintains a yearly average accuracy rate of 94% during internal and/or external Coding audits. - Verifies patient information to identify any discrepancies and ensures that all codes and any other abstracted information is applied to the appropriate patient's encounter. - While reviewing the record for coding purposes, serves as a quality reviewer, and identifies any documents not belonging to the patient, or the correct patients encounter. - Ensures the accuracy when using the appropriate modifiers while coding out patients encounters. - Assesses documentation and if necessary queries the physician for additional information when indicated to clarify a diagnosis, symptom or any reason for services provided. - Makes sure all codes are utilized to reflect the care rendered to the patient which in return will ensure patient safety, accuracy of data retrieval and provides the organization with accurate reimbursement for the care provided to the patient. - Evaluates to determine that data documented substantiates the diagnosis and treatment and is internally consistent as required by accreditation standards. - Recognizes and reports unusual circumstances and/or information with possible risk factors to the Coding Assistant Administrator, Coding Associate Administrator or the Coding Director. - Meets continuing education requirements established by American Health Information Management Association (AHIMA) and/or American Association of Professional Coders (AAPC) to maintain appropriate certification and competency in job skills and knowledge. Meets productivity standards according to AHIMA Guidelines depending on outpatient record type. - (Clinics, ER, Recurrent, Diagnostics) Is actively involved in all ICD-10 education sessions provided by Jackson Health Systems. - Shows competency according to education received. - Participates in educational requirements by JHS, including but not limited to Safety, Infection Control, AIDS Awareness, etc. Follows hospital wide and department specific standards for safety and infection control. - Adheres to the Standards of Excellence at all times, and respects the rights, privacy and property of others at all times including the confidentiality of information, according to Administrative Policies HIPAA Guidelines and all applicable laws and regulations. - Demonstrates behaviors of service excellence and CARE values (Compassion, Accountability, Respect and Expertise). - Performs other related duties as assigned. Experience Generally requires 0 to 3 years of related experience. Education High School diploma is required. Skill - Ability to analyze, organize and prioritize work accurately while meeting multiple deadlines. - Ability to communicate effectively in both oral and written form. - Ability to handle difficult and stressful situations with critical thinking and professional composure. Ability to understand and follow instructions. - Ability to exercise sound and independent judgment. - Knowledge and skill in use of job appropriate technology and software applications. Credentials Employee hired AFTER June, 2015 must be credentialed with an HIM/Coding Credentials and/or Certification by AHIMA or AAPC. Jackson Health System is an equal opportunity employer and makes employment decisions without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability status, age, or any other status protected by law.