• 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

• Process payments received and create batches for posting. • Identify underpayments and prepare appeals documents. • Code claims accordingly with CPT and ICD 10s codes. • Submit claims to clearinghouses and update or review claims corrections. • Communicate with patients, providers, and payers to check eligibility, pre-certify, or follow up on claims and appeals • Perform other duties as assigned by management