Role Description Coordinates, completes and provides supervision for the primary operational functions of Medical Staff Services including but not limited to credentialing, privileging, proctorship, and orientation. Serves as a resource for the VPMA, Medical Staff, and others. Applies knowledge of regulatory/accreditation standards to maintain Medical Staff and Hospital compliance. States eligible for remote work: SD, FL, GA, KY, OH, SC, TN, TX, VA, WY. Essential Functions - Compiles credentialing, privileging, and peer review actions for the Board of Directors’ Quality Committee. - Acts as resource and assists Department Chairpersons and Credentials Committee members to obtain information required when they review the application. - Plans, organizes and directs confidential research required for initial appointees and recredentialing/reappointment (physicians, dentists, AHPs). - Develops and provides oversight for the orientation program for new appointees (physicians, dentists, and AHPs). - Maintains and updates the proctorship review forms, files, and process to maintain compliance with regulations outlined by the Joint Commission and other agencies. - Assists in the VPMA and Bylaws Committee in maintaining and revising pertinent documents. - Responds timely and appropriately to Joint Commission and other surveys, coordinates successful completion, and assists in the development of any necessary action plans. - Evaluates document revisions for Joint Commission and other regulatory compliance. - Utilizes the MIDAS database efficiently and effectively for tracking, reporting, and other processes. - Assists the VPMA, Medical Staff, and others with special projects as requested. - All other duties as assigned. Qualifications - Education - High School Diploma/GED Equivalent in General Studies - Preferred Experience - 1+ years of Healthcare Experience; 1+ years of Medical Staff Experience; 1+ years of Regulatory Guidelines Experience - Preferred Education - Associates degree in Healthcare - Preferred Certification - Certified Provider Credentialing Specialist (CPCS) - Accredited University or accredited training professionals Requirements - Physical Requirements: Sedentary work - Exerting up to 10 pounds of force occasionally and/or negligible amount of force frequently or constantly to lift, carry, push, pull or otherwise move objects, including the human body. Sedentary work involves sitting most of the time. Benefits - Supportive work culture - Medical, Vision and Dental Coverage - Retirement Plans, Health Savings Account, and Flexible Spending Account - Instant pay is available for qualifying positions - Paid Time Off Accrual Bank - Opportunities for growth and advancement - Tuition assistance/reimbursement - Excellent pay differentials on qualifying positions - Flexible scheduling Company Description Monument Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, or protected Veteran status.

Role Description The Medical Records Coder II is a certified Coder responsible for coordinating and reviewing the work of subordinate employees and assisting with training and continuing education programs. Key responsibilities include: - Code medical records utilizing ICD-10-CM and CPT-4 coding conventions. - Review medical records to assure specificity of diagnoses, procedures, and appropriate reimbursement. - Abstract information from medical records following established methods and procedures. - Review complex medical records and accurately code primary/secondary diagnoses and procedures. - Coordinate/review the work of designated employees. - Ensure quality and quantity of work through regular audits. - Assist with research, development, and presentation of continuing education programs. - Consult with and educate physicians on coding practices. - Communicate with nursing and ancillary services for needed documentation. - Maintain understanding of anatomy, physiology, medical terminology, and coding guidelines. - Assist with special projects as required. - Perform other related duties incidental to the work described herein. Qualifications - Advanced ICD-10-CM & CPT-4 coding conventions. - Anatomy and Physiology knowledge. - Medical Terminology proficiency. - Extensive DRG/APC reimbursement knowledge. - Coding software familiarity. - Effective written and verbal communication skills. - Data entry/CRT skills. Requirements - High school diploma required. - Must hold one of the following active/current certifications: - Registered Health Information Administrator (RHIA) - Registered Health Information Technician (RHIT) - Certified Coding Specialist (CCS) - Certified Professional Coder (CPC) - Homecare Coding Specialist-Diagnosis (HCS-D) - RHIA certification - no experience required. - RHIT certification - no experience required. - CCS certification - one year of coding experience required. - CPC or HCS-D certification - two years of coding experience required. Benefits - 100% remote position. - Must reside in one of the following states: North Carolina, Virginia, South Carolina, Tennessee, Florida, or Texas.

Role Description This position performs technical and specialized Capstone functions. The Coding Team Supervisor oversees the coding services' organizational, developmental, and functional integrity, ensuring staff compliance, development, and education. The manager is responsible for the security and accuracy of the patient record, which requires remaining current with software and network security issues. The Coding Team Supervisor coordinates and supervises day-to-day operations within the coding team under the direct supervision of the Sr. Manager of Risk Adjustment. Responsibilities - Manage activities of 10 or more professional medical coders to ensure compliance with departmental policies, standards, procedures, and applicable regulatory requirements. - Assist staff, as needed, to complete work and ensure all expected standards are optimally working. - Problem-solving, troubleshooting, and appropriately escalating issues to higher level management (Sr Manager of Risk Adjustment) as necessary. - Develop and coordinate educational and training programs regarding coding elements such as appropriate documentation, accurate coding, coding trends found during chart reviews, third-party audit findings, internal quality reviews, and annual coding updates. - Collaboration with other Capstone teams to provide as-needed and quarterly education to clients. - Determine efficient workflows and prioritize caseload to ensure fair work distribution. - Monitor and assess the performance of coding staff to ensure accurate code assignment and timely completion of coding tasks. - Collaborate with the Sr Manager of Risk Adjustment to deliver performance improvement and/or corrective action related to performance, attendance, and conduct. - Provides direction and mentoring of coding staff to ensure their understanding of coding principles and correct coding initiatives. - Perform clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that apply to Medicare Risk Adjustment reimbursement initiatives. - Perform reviews for prospective and retrospective audits and RADV audits when necessary. - Provide feedback and process improvement recommendations to appropriate health plan operations departments, participate in workgroups/committee meetings, and process improvement solutions as required. - Advise Sr Manager of possible trends in inappropriate utilization and other quality issues. - Participate as requested in department meetings, client calls, and performance evaluation and management. - Provide floating coding coverage to fill in for PTO, backlogs, and irregular projects as permissible. - Reviews bulletins, newsletters, and periodicals and attends workshops to stay abreast of current issues, trends, and changes in the laws and regulations governing medical ICD-10 CM coding and documentation. - Performs other duties and responsibilities as required. - Completes miscellaneous projects for Capstone as assigned or requested. - Maintains professional license and certifications and attends training conferences/webinars as necessary to keep abreast of the latest trends in the field of expertise. - Understands and adheres to The Health Insurance Portability and Accountability Act (HIPPA) requirements. Qualifications - Associate’s degree or formal training beyond high school is required. - Certified Coding Specialist designation (CCS) issued by the American Health Information Management Association or, Certified Professional Coder (CPC), or Registered Health Information Administrator (RHIA) or Registered Health Information Technologist (RHIT). - Bachelor’s degree in related field is preferred. - 5+ years of professional work experience in a health plan setting. - 5+ years of professional experience of risk adjustment coding experience. - Strong knowledge of Clinical Documentation Improvement. - Strong knowledge of Hierarchical Condition Categories (HCC). - Knowledge of or experience in Medicare Advantage plans. - Strong experience in managed health care systems, PACE, or Medicare. Skills & Abilities - Knowledge and experience using current computer technology, and a strong knowledge of Microsoft 365 Applications; ability to easily adapt to new systems. - Excellent written and verbal communication skills, and professionalism when working with clients. - Ability to read, comprehend and analyze provider contracts. - Ability to summarize complex issues and communicate them in a way that is clearly understandable by clients. - Ability to solve problems under pressure by making immediate decisions while on the phone/in-person. - Detail oriented and able to prioritize workload. - Strong computer skills and ability to navigate spreadsheets, reports, documents and database and proprietary software. - Ability to manage multiple priorities and work independently. - Skilled in problem resolution and root cause analysis. - Skilled in establishing and maintaining effective working relationships, with internal and external customers. - Ability to demonstrate resourcefulness and resolve issues in a timely manner. - Ability to work independently with minimal supervision. - Ability to communicate professionally, clearly, and effectively, verbally and in writing. - Ability to prioritize effectively. Physical/Mental Demands This position is administrative in nature and will present physical demands requisite to a position requiring: hearing, seeing, sitting, standing, talking, and walking. The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Must be able to commute to multiple site locations within assigned territory. May be necessary to work extended hours as needed. Schedule This is a full-time position with an expectation to work an average of 40 hours per week and be available outside of normal business hours to meet customer expectations on an ad-hoc basis. Schedules are set to accommodate the requirements of the position and the needs of the organization and may be adjusted as needed. Travel Travel may be required for special organization or department events, department team meetings, trade shows, conferences, and other client engagements. This is a remote position. Benefits - Medical/dental/vision coverage effective 1st of the month following date of hire. - Flexible spending. - Company-paid life insurance and short-term disability. - Voluntary benefits. - 401(k). - Paid Time Off and paid holidays.

Role Description To ensure accurate and appropriate gathering of information into the coding classification systems to meet departmental, hospital and outside agency requirements. This includes ensuring appropriate reimbursement, compliance and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding/MS-DRG assignment, severity of illness and risk of mortality for each medical record. Must code inpatients and/or interventional RAD cardiology/radiology 90% of current FTE status. Responsible for the coding of the highly complex patient classes i.e. inpatient, interventional, etc. Qualifications - High School Diploma or Equivalent. - Current HIM or Coding Certification through one of the following: - American Health Information Management Association (AHIMA) - American Academy of Professional Coders (AAPC) - Three (3) years of hospital inpatient coding or interventional radiology (IRAD) hospital coding experience. Requirements - Graduate of Health Information Technology (HIT) or equivalent program OR Medical Coding Certification Program. - Codes inpatient and/or IRAD 90% of current FTE status. - Reviews and accurately interprets medical record documentation from all hospital accounts to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10-CM, ICD-10-PCS, CPT, or modifier codes for each diagnosis and procedure that is identified (inpatient and IRAD). - Ensures appropriate MS-DRG assignment based on accurate ICD-10-CM and ICD-10-PCS coding assignment and medical record documentation. - Assigns hospital codes to a variety of patient classes (i.e. I/P, IRAD, etc.). - Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas. - Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals. - Assures the accuracy, quality, and timely review of data needed to obtain a clean bill. - Contacts physicians or any persons necessary to obtain information required for accurate code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process. Physical Requirements - Must be able to sit for long periods of time. - Must have visual and hearing acuity within the normal range. - Must have manual dexterity needed to operate computer and office equipment. Working Environment - Standard office environment. - Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material. - May require travel. Skills and Abilities - Must be able to concentrate and maintain accuracy during constant interruptions. - Must possess independent decision-making ability. - Must possess the ability to prioritize job duties. - Must be able to handle high stress situations. - Must be able to adapt to changes in the workplace. - Must be able to organize and complete assigned tasks. - Must possess excellent written and verbal communication skills. - Must possess the knowledge of anatomy, physiology and medical terminology. Additional Job Description - Scheduled Weekly Hours: 40 - Shift: Exempt/Non-Exempt: United States of America (Non-Exempt) - Company: SYSTEM West Virginia University Health System - Cost Center: 538 SYSTEM HIM CDI