Role Description Performs complex retrospective analysis of medical record documentation to identify coding and billing errors and inconsistencies according to guidelines of the AHA, CMS, AMA, Clinic Coding Clinic and CPT Assistant. - Analyzes audit findings to identify potential root causes of coding errors and prevent their reoccurrence. - Provides second-level review of diagnosis, procedure and billing codes to ensure compliance with legal and procedural policies that ensure optimal reimbursements while adhering to regulations prohibiting unbundling and other questionable practices. - Researches, analyzes and responds to inquiries regarding compliance, inappropriate coding, denials and billable services. - Provides technical support and feedback training to internal coding staff regarding coding compliance, documentation, regulatory provisions, third party payer requirements, medical necessity requirements. - Protects the privacy and confidentiality of patient health and client information. - Follows the Standards of Ethical Coding as set forth by AHIMA and adheres to official coding guidelines and compliance practices. - Suggests physician query opportunities based on documentation and clinical needs. - Prepares deliverables for the coders as required. - Reports work time and work productions in a timely and accurate manner. - Communicates with coworkers in an open and respectful manner which promotes teamwork and knowledge sharing. - Provides schedule of planned work activities, events and sites, and any changes to management and appropriate staff. - Maintains professional coding credentials and knowledge of coding, reimbursement methodologies and compliance issues through education. - Monitors the ongoing progress and success of each coder. - Maintains QA percentages within two internal quality goals: - Overall minimum coder accuracy of 95% - QA review percentages as close to 10% as possible. - Identifies and resolves coding quality problems or issues in a timely manner. - Maintains continual knowledge of problems or issues that could affect coding quality levels. - Assists in design of systems to help improve coder productivity and assist in improving accuracy of coding. - Provides monthly reports. - Participates in corporate training and meetings. - Provides status reports to senior manager as requested. - Aligns conduct with AHIMA's Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct and supports the Company’s Ethics and Compliance Program. - Interprets coding guidelines for accurate code assignment. - Identifies the importance of documentation on code assignment and the subsequent reimbursement impact. - Complies with all internal policies and procedures. - Actively participates in Company provided training and education. - Ensures individual compliance with all privacy and security rules and regulations and commits to the protection of all Company confidential information, including but not limited to, Personal Health Information. Qualifications - Regular, predictable and punctual attendance is required. - Strong verbal and written communication skills are required. - Ability to prioritize workload, meet deadlines and maintain a high level of quality and accuracy. - Recognized coding credential from AHIMA or AAPC; RHIA or RHIT may also be considered. - Experience with telecommuting and electronic medical records systems strongly preferred. - Strong analytical skills. - Excellent written communication skills. - Strong team player. - Ability to work with multiple and diverse clients and projects. - Ability to work with minimal supervision. - Minimum 3 years of Profee coding experience and/or auditing in an acute care facility or multispecialty clinics. - Initiative, resourcefulness and attention to detail. - Customer service support -- minimum one (1) year experience. - Familiarity with hospital outpatient billing processes. - Understand hospital APC assignment and associated coding and documentation. - Coding Certification -- preferred (CPC or CCS). - Strong communication skills, proficient in Microsoft Office applications including Word and Excel. - Ability to navigate in a variety of EMR environments and review hand-written charts. Physical Demands Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

Role Description Under general supervision, performs all functions associated with the appropriate assignment of ICD, HCPCS/CPT, and E&M codes for outpatient and/or inpatient encounters. - Assigns the appropriate ICD, HCPCS/CPT, and E&M codes, as applicable, to diagnoses and procedures generated for outpatient or inpatient encounters, maintaining a 95% accuracy rate in conjunction with meeting productivity standards. - Abstracts demographic and clinical data for performance improvement, research, reporting, and reimbursement purposes in relation to assigned areas of work by use of a computerized encoding system. - Validates charges on accounts/charge sessions. - Effectively interacts with providers and ancillary staff for clarification of coding issues. - Maintains statistics, records, and logs in relation to assigned work area. - Assists with the training and in-services of students and new employees in specific areas of assignment as directed by management. - Keeps educated about current coding updates per management’s direction – including ICD-10-CM, HCPCS/CPT, and E&M code guidelines and methodologies, as well as payor requirement changes as applicable. - Keeps management informed of coding problems/issues. - Represents coding on teams, committees, and task forces as assigned by management. - Actively participates in other duties as assigned, but only after appropriate training. Qualifications - Must have completed an American Health Information Management Association (AHIMA) approved program for Certified Coding Specialist, -OR- Health Information Technician (2 year degree), -OR- Health Information Administrator (4 year degree). - Certifications obtained: Certified Professional Coder (CPC) by an AAPC recognized program, -OR- Certified Coding Specialist-Professional (CCS-P), Registered Health Information Technician (RHIT), -OR- Registered Health Information Administrator (RHIA) by an AHIMA recognized program. - One year of coding experience is preferred -OR- an approved equivalent combination of education and experience. Requirements - Ability to communicate effectively both orally and in writing. - Ability to work independently with minimal direction.

Role Description Utilizing an electronic medical record and computerized encoder, assigns and sequences diagnosis and procedure codes and present on admission indicators for inpatient encounters based on medical record documentation in accordance with Official Coding Guidelines, CMS regulations, encoder software guidance and Health Information Management (HIM) policies and procedures. - Reviews and validates accuracy of Admission-Discharge-Transfer (ADT) data fields. - Abstracts discharge disposition, physicians, procedure dates, and present on admission (POA) indicators. - Maintains strict adherence to patient confidentiality according to MHS Standards and regulatory requirements. - Reviews inpatient medical records to assign and sequence all appropriate diagnosis and procedure codes utilizing encoder software and following official coding guidelines. - Reviews Medicare Severity Diagnosis Related Groups (MSDRGs) and All Patient Refined Diagnosis Related Groups (APRDRGs) for appropriate code assignment. - Performs all other duties as requested. - Attends educational meetings and seminars to maintain certification and continuing education requirements. - Meets and maintains Memorial Healthcare System (MHS) coding quality and productivity standards. - Submits daily productivity report to manager by defined deadline. - Formulates physician queries for validation of pathological findings. - Requests clinical validation queries for Clinical Documentation Integrity (CDI) review and follow-up. - Seeks clarification from providers or other designated resources to ensure accurate and complete coding. - Reviews appropriate inpatient coding work queues daily to address coding edits and needed corrections and follows procedure to notify billing as needed. - Reviews accounts and performs needed correction for internal audits and external denials. Qualifications - High School Diploma or Equivalent (Required) - Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) Requirements - Three (3) years inpatient coding experience in a hospital setting or a graduate of the MHS coder intern program. - Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), or Certified Coding Specialist (CCS). - Focused education of hospital-based coding. Company Description Memorial Healthcare System is proud to be an equal opportunity employer committed to workplace diversity. - Memorial Healthcare System recruits, hires and promotes qualified candidates for employment opportunities without regard to race, color, age, religion, gender, gender identity or expression, sexual orientation, national origin, veteran status, disability, genetic information, or any factor prohibited by law. - We are proud to offer Veteran’s Preference to former military, reservists and military spouses (including widows and widowers).

Role Description Under general supervision, performs all functions associated with the appropriate assignment of ICD codes. Performs coding for inpatient hospital billing. - Assigns the appropriate ICD codes to diagnoses and procedures on inpatient cases - Assigns the correct DRG based on the coded diagnostic and procedural information on inpatient cases - Assigns the correct POA to corresponding diagnoses - Abstracts demographic and clinical data (including quality assurance) from the patient’s medical record - Effectively interacts with providers for clarification of coding/documentation issues - Initiates, reviews, and/or edits physician queries where appropriate - Maintains or exceeds established accuracy and productivity standards - Maintains statistics, records, and logs in relation to assigned work area - Assists with the training and in-services of students and new employees in specific areas of assignment as directed by management - Keeps educated about current coding updates per management’s direction – including ICD coding guidelines and DRG methodologies - Keeps management informed of coding problems/issues - Represents coding on teams, committees, and task forces as assigned by management - Actively participates in other duties as assigned, but only after appropriate training Qualifications - Must have completed an American Health Information Management Association (AHIMA) approved program for Certified Coding Specialist, -OR- Health Information Technician (2 year degree), -OR- Health Information Administrator (4 year degree) - Five years of coding experience - Certification Required: Certified Coding Specialist (CCS), Registered Health Information Technician (RHIT), or Registered Health Information Administrator (RHIA) by an AHIMA recognized program Requirements - Ability to communicate effectively both orally and in writing - Ability to work independently with minimal direction