• Accurately assign all codes (ICD-10-CM/PCS, CPT, HCPCS) for highly complex professional fee encounters (highest complexity level) or moderate to high complexity facility encounters • Serve as the authoritative internal expert for professional coding guidelines or a knowledgeable resource for facility guidelines. • Provide expert guidance, training, onboarding assistance, and mentorship to Coder I/II staff to enhance team performance and accuracy • Provide informal code review guidance as directed by leadership, focusing purely on the accuracy of code assignment and documentation translation for complex cases. • Review accounts placed on pre-bill hold to address specific coding edits, complex claim issues, and/or denial prevention strategies before final billing • Master and interpret complex regulatory updates and official coding guidelines (e.g., AHA Coding Clinic), translating changes into actionable processes for the team

• Assign the appropriate surgical and office procedural and diagnostic (CPT - E/M, surgical and ICD) codes to individual patient health information. • Utilizes advanced knowledge of specialty coding, including surgical procedures. • Abstract pertinent data and resolve edits within specified time frames. • Exhibit Mount Carmel Service Excellence Behavior Standards holding self and others accountable. • Meet population specific and all other competencies according to department requirements. • Create a caring and healing environment that keeps the patient and family at the center of care. • Reviews and evaluates patient medical records to determine the level of Evaluation and Management (E/M) service. • Queries physicians for clarification in coding purposes when needed. • Keeps abreast of coding guidelines and brings identified concerns to manager. • Monitors and investigates records that are not coded, billed or rejected. • Responsible for enhancing coding skills to enable accurate and timely coding.

• Review inpatient hospital records and assign accurate diagnosis and procedure codes • Determine the appropriate MS-DRG or APR-DRG assignment based on coding and clinical documentation • Conduct coding validation and auditing to ensure compliance with payer and regulatory requirements • Identify documentation gaps and communicate opportunities to providers, hospitals, and Clinical Documentation Improvement (CDI) teams • Analyze denials and underpayments related to coding and DRG assignment • Support retrospective and concurrent reviews of high-cost admissions and outlier cases • Collaborate with utilization management, case management, finance, and contracting teams to optimize reimbursement and cost containment • Assist with internal and external audits, including RAC, Medicare Advantage, Medicaid, and commercial payer reviews • Provide education and mentoring to coding staff and other stakeholders • Monitor changes in coding guidelines, reimbursement methodologies, and regulatory requirements • Prepare reports and summaries related to coding accuracy, financial impact, and audit findings • Maintain confidentiality and compliance with HIPAA and company policies • Other duties as assigned

• review medical records to identify pertinent diagnoses and procedures • select principal diagnosis and procedures using UHDDS definitions • ensure appropriate DRG assignment • abstract information from medical records based on client guidelines • meet productivity and quality performance requirements • utilize company applications to enter charts coded in real-time • solicit clarification from physicians regarding documentation • participate in team meetings and training • contribute to coding education within the team