• Plan and perform medical record audits to determine coding accuracy and compliant claims submission • Conduct analysis of audit findings to identify trends/problems in coding and documentation • Monitor relevant resources, publications, and current government compliance and enforcement activity

Role Description Constellation Health is seeking a dynamic PART TIME and REMOTE CODER to join our team! Must live in one of these states: Texas, Pennsylvania, Maine, Massachusetts, or Ohio. This role involves 20-25 hours per week with a flexible schedule. The Home Health/Hospice Coder is responsible for accurately coding patient medical records and claims for home health and hospice services. This role ensures compliance with coding guidelines, assists in proper billing, and contributes to the efficiency of the healthcare facility’s financial operations. Essential Job Responsibilities - Review clinical documentation from home health and hospice providers to accurately assign appropriate ICD-10, CPT, and HCPCS codes for diagnoses, treatments, and procedures. - Maintain knowledge of coding regulations and guidelines (such as ICD-10, HCPCS Level II, and CMS rules), ensuring all codes are compliant with local, state, and federal policies, including Medicare and Medicaid requirements. - Perform chart reviews to verify that all services, diagnoses, and treatments are properly documented and coded, ensuring that all necessary information is included for accurate billing. - Work to resolve any coding discrepancies or claim rejections. - Generate coding reports and track coding metrics. Qualifications - Education: High school diploma or equivalent required. - Certifications: CPC (Certified Professional Coder), CCS (Certified Coding Specialist), or CHHCS/HCS-D (Certified Home Health Coding Specialist) preferred. - Experience: 2-3 years previous office/billing/medical records experience preferably in a Healthcare Environment. Previous coding experience in home health or hospice settings preferred. - Skills: - Proficient knowledge of ICD-10, CPT, and HCPCS coding. - Familiarity with home health and hospice regulations, including Medicare and Medicaid billing procedures. - Intermediate functional knowledge of computer/technology skills including, but not limited to MS Office, MS Excel, navigation of company website, and electronic medical records. - Strong attention to detail, organizational skills, and the ability to maintain confidentiality. - Ability to handle multiple tasks, work at a fast pace with attention to detail and accuracy. - Excellent communication skills to collaborate with clinical and billing teams. Company Description

• Responsible for conducting file audits for all areas of clinical operations. • Conduct quarterly file audits for all lines of business against business Process Flows to determine compliance with regulatory standards according to NCQA, URAC and CMS. • Analyze, prepare, and distribute quarterly audit outcomes including error trends, to the Business Unit Directors. • Conduct monthly CMS-CAPs audits against business Process Flows in order to evaluate compliance with Medicare standards. • Primary responsibility for documentation of CMS-CAPs results in SharePoint database and generation of communication/notification to Directors regarding the outcome including the analysis of error trends. • Serves as database administrator and facilitates biannual MCG-IRR testing (Milliman Care Guidelines-Inter Rator Reliability) that is administered to clinical and medical director staff. • Conduct ad hoc file audits against business process flows when new business practices are set in place to monitor adherence to Process Flow as it relates to regulatory compliance. • Completes other assigned functions, including special projects, as requested by management.

• Review inpatient medical records for validation of DRG assignment • Provide detailed rationale and supporting evidence for the recommendation and findings • Utilize industry-recognized references to support their review findings, such as the ICD-10 Official Guidelines for Coding and Reporting, AHIMA Standards of Ethical Coding, AHIMA Practice Briefs related to compliant querying, and AHA Coding Clinics