• Utilize available encoder, grouper software, and other coding resources to determine appropriate ICD-10-CM, CPT, and/or HCPCS including specialty specific codes and Evaluation and Management (E&M) codes. • Maintain understanding and apply knowledge of National Correct Coding Initiatives (NCCI), Local Coverage Documents and National Coverage Documents (LCD/NCD) directives, Medically Unlikely Edits (MUEs), and Medicare Teaching Physician Guidelines. • Resolve payer denials and respond to inquiries from revenue cycle teams, processing charge corrections as appropriate.

Role Description The Coder I Specialist - Professional Hospitalist/Office Visits reviews electronic medical record documentation and applies ICD and CPT codes, per Official Coding Guidelines, with a specific focus on professional hospitalist and office visits. This position abstracts key data elements necessary for billing and data analysis. - Accurately reviews and codes patient records in the following clinical areas: hospitalist rounds and office visits (with repetitive or non-invasive procedures). - Reviews and analyzes the content of the medical record to determine when documentation should be utilized for appropriate assignment of ICD diagnosis codes, CPT repetitive or non-invasive procedure codes, modifiers, hierarchical condition categories, complications, and comorbidities to meet coding guidelines. - Evaluates appropriateness of diagnosis and procedure codes and modifiers utilized in response to Outpatient Code Editor and National Correct Coding Initiative edits. - Reviews clinical documentation to validate accurate representation of the patient's clinical picture, treatment, and diagnoses. - Identifies when documentation relevant to the coding process is missing, lacks specificity or is inconsistent and takes steps to obtain the documentation. - Identifies and enters data elements for abstracting. - Meets defined coding accuracy standards. - Meets defined coding productivity standards. - Applies broad guidelines to specific coding situations, independently utilizing discretion and a significant level of analytic ability. - Understands how diagnosis and procedure codes, and reimbursement methodologies are used to determine reimbursement, public reporting of outcomes, quality of patient care, financial modeling, strategic planning, and marketing. - Remains current with coding and industry changes through participation in educational opportunities. - Demonstrates a thorough knowledge of professional coding guidelines, medical terminology, anatomy/physiology, and payer specific coding guidelines. - Notifies coding leadership of trends and topics for education and feedback to physicians and departments. - Assists with identification and implementation of process improvements, according to industry best practice standards to make the best use of resources, decrease costs and improve coding services across the specialized service lines. - Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association/American Association of Procedural Coders and adheres to official coding guidelines. Qualifications - High School Diploma/GED - Required - Associate's Degree, Health Information Management - Preferred - Bachelor's Degree, Health Information Management - Preferred - 2 years Coding - Preferred - Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - Required - or Certified Professional Coder Associate (CPC-A) - American Academy of Professional Coders (AAPC) - Required - or Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) - Required - or Certified Coding Specialist - Physician (CCS-P) - American Health Information Management Association (AHIMA) - Required - or Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA) - Required - or Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) - Required - or Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) - Required Requirements - TRAVEL IS REQUIRED: Never or Rarely - JOB RANGE: Coder I Specialist - Hospitalist/Office Visit E&M $18.02-$26.81 - INCENTIVE: Not Applicable Equal Opportunity Employer It is the policy of Franciscan Alliance to provide equal employment to its employees and qualified applicants for employment as otherwise required by an applicable local, state or Federal law. Franciscan Alliance reserves a Right of Conscience objection in the event local, state or Federal ordinances that violate its values and the free exercise of its religious rights. Franciscan Alliance is committed to equal employment opportunity. Benefits Franciscan provides eligible employees with comprehensive benefit offerings. Find an overview on the benefit section of our career site, jobs.franciscanhealth.org.

• Submit insurance claims accurately and in a timely manner. • Verify patient insurance eligibility and benefits. • Follow up on unpaid, pending, and denied insurance claims. • Manage Accounts Receivable (A/R) and reduce outstanding balances. • Contact insurance companies regarding claim status, corrections, and appeals. • Monitor billing reports and identify opportunities to improve collections. • Maintain accurate billing records and documentation. • Help ensure timely reimbursement and consistent revenue collection. • Assist with incoming phone calls during overflow periods. • Support prior authorization requests when needed. • Help with general administrative tasks during lighter billing periods.

• conducts quality assurance coding of medical records and ICD-10 diagnosis codes • assumes ownership and leads advanced and specialized administrative/operational/customer support duties • ensures coding is accurate and supported by clinical documentation • reviews medical records to report conditions that map to HCCs by applying the appropriate ICD-10 diagnosis codes • follows state and federal regulations and internal policies while analyzing coding info • works on projects that may include making phone calls to providers • participates on special projects in addition to daily responsibilities