Role Description - Complies with all policies and procedures that pertain to HIPAA including minimum necessary requirements for this position. Must maintain 100% patient confidentiality for e-PHI during the course of work functions. - Responds to inquiries from Business Office on patient claims resolution. - Assists coding team with inquiries from departments to achieve timely resolution. - Assists coding team to ensure coding accuracy, completeness, and adherence to established guidelines and standards. - Participates in meetings with Revenue Cycle Committee and coding team. - Abides by the Standards of Ethical Coding set forth by AHIMA and monitors coding staff for violations and reports as areas of concern are identified. - Assists HIM Director in maintaining compliance with applicable regulations (e.g., ICD-10, CPT, or internal standards). - Trains new staff and existing staff on coding standards, tools, and updates. - Maintains knowledge of current professional coding certification requirements and promotes recruitment and retention of certified staff in coding positions. - Develops reports and collects and prepares data for studies involving cases for clinical evaluation purposes, fiscal impact, and profitability. - Assists HIM Director with developing and implementing coding policies, procedures, and best practices. - Assists HIM Director with tracking key performance metrics such as accuracy rates, productivity, and turnaround times. - Keeps abreast of recent technology in coding software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding function. - Demonstrates competency in the use of computer applications and grouper software, medical edits, and all coding software and hardware. - The supervisor should demonstrate initiative and discipline in time management and assignment completion. - The supervisor must be able to work in a virtual setting under minimal supervision. Qualifications - Required Education: Associate or bachelor’s Degree and accredited by AHIMA. - Required Licenses and/or Certifications: Certified Coding Specialist (CCS) and Certified Professional Coder (CPC) Certifications. - Required Work Experience: Five (5) years in relevant working field, with one (1) year of supervisory experience. - Required Knowledge, Skills, and Abilities: - Advanced knowledge of ICD-10-CM and CPT coding principles and rules. - Strong leadership and communication skills. - Problem solving. - Good knowledge of medical records systems. - Excellent computer applications knowledge including Microsoft Word and Excel. - Must be fluent in general information technologies. - Significant level of autonomy, must be self-directed. - Intermediate to advanced knowledge of disease pathophysiology and drug utilization. - Intermediate to advanced knowledge of MS-DRG and APR-DRG classification and reimbursement structures. - Advanced knowledge of APC, OCE, NCCI classification and reimbursement structures. - Excellent organizational skills for initiation and maintenance of efficient workflow. - Regular and reliable attendance and time reporting per Gritman Medical Center Telecommuting program requirements. - Capacity to work independently in a virtual office setting or at hospital setting if required to travel for assignment. - Good visual acuity. - Ability to operate computer keyboard, mouse, and other peripherals as appropriate to accomplish coding. Preferred Qualifications - Prefer five (5) years' experience in a supervisory role in healthcare with extensive knowledge of ICD-10-CM, CPT, HCPCS, and documentation guidelines. - EPIC experience, including HB and PB billing.

Role Description We are seeking an exceptionally analytical, detailed-oriented, and results-driven Virtual Medical Biller / Accounts Receivable (A/R) Specialist to manage the revenue cycle operations for our premium ophthalmology practice. This is not a passive data-entry role. We are looking to internalize and elevate our financial operations by adding a dedicated billing professional to improve claim resolution, drastically reduce outstanding accounts receivable, and optimize our revenue cycle alongside an existing outsourced team. - Accounts Receivable (A/R) & Full Revenue Cycle Management - End-to-End RCM Oversight: Manage the complete medical billing lifecycle from clean claim submission through to final payment allocation, ensuring zero gaps in the financial pipeline. - Aggressive A/R Recovery: Review aging reports, prioritize outstanding balances, and actively follow up with insurance carriers regarding unpaid, underpaid, or delayed claims to consistently optimize cash flow. - Audit & Documentation: Maintain meticulous documentation of all collection efforts, payer communications, and billing files within the clinical ecosystem. - Denials, Appeals & Compliance - Denial Investigation: Deeply investigate denied or rejected claims to pinpoint root causes, correct claim errors, and execute rapid resubmissions. - Appeals Management: Prepare, document, and submit clinical and administrative appeals with solid supporting documentation, monitoring status through to final resolution. - Specialty Coding & Medical Necessity: Review CPT, ICD-10, and modifier usage for total billing accuracy. Ensure all submitted claims strictly meet payer-specific guidelines and satisfy medical necessity criteria. - Ophthalmology Domain Expertise: Minimum of 2–3 years of specialized medical billing experience specifically within Ophthalmology or Retina practices. Ophthalmology surgery billing experience is a major asset. - Payer Fluency: Solid, practical working knowledge of Medicare and Medi-Cal billing guidelines, reimbursement structures, and compliance standards. - Software Literacy: Hands-on proficiency navigating DrChrono EMR is strongly preferred. Strong technical competency with digital clearinghouses and billing analytics tools is required. - Phonetic & Verbal Excellence: Flawless verbal and written English communication skills. Must be highly articulate and professional when negotiating with insurance adjusters and collaborating with internal staff. - Remote Workspace: Full-time availability (40 hours per week). Ability to work completely independently from a silent, distraction-free virtual home office. Qualifications - Proactive and highly analytical. - Solution-oriented mindset. - Ability to identify recurring denial trends and implement workflow improvements. - Built for a fast-paced specialty environment. - Pride in keeping an A/R aging ledger exceptionally clean.

Role Description BJC is hiring for an Inpatient II Coder. We are looking for 2 years of Inpatient Hospital Coding experience. This is a remote position. - Must have one of the following certifications: CCS, RHIA, or RHIT - Eligible remote states: - Alabama - Kentucky - Oklahoma - Arkansas - Louisiana - South Carolina - Florida - Mississippi - Tennessee - Georgia - Texas - Indiana - North Carolina - Wisconsin - Iowa - Ohio Qualifications - High School Diploma or GED - 2-5 years of experience - No supervisor experience - Cert/Lic in Area of Expertise: CCS, RHIA, or RHIT Requirements - Accurately abstracts data elements as required. - Stays current of all changes in coding conventions, regulatory guidelines, code updates and BJC coding guidance. - Thoroughly reviews and analyzes patient encounters for compliant coding. Queries provider for clarification or additional information as required. - Accurately assigns codes in a timely manner. Interprets, assesses and evaluates provider documentation for appropriate DRG assignment. - Effectively collaborates with leadership, colleagues and customers (CDI, HIM Operations, and other departments) as appropriate to ensure the integrity of the medical record and coding compliance. Benefits - Comprehensive medical, dental, vision, life insurance, and legal services available first day of the month after hire date - Disability insurance paid for by BJC - Annual 4% BJC Automatic Retirement Contribution - 401(k) plan with BJC match - Tuition Assistance available on first day - BJC Institute for Learning and Development - Health Care and Dependent Care Flexible Spending Accounts - Paid Time Off benefit combines vacation, sick days, holidays and personal time - Adoption assistance

• Review home health and hospice clinical documentation across all time points (SOC, ROC, Recertification, Transfer, Discharge, Admission) to assign accurate ICD-10-CM diagnosis codes. • Sequence diagnoses in strict compliance with ICD-10-CM guidelines, CMS requirements, PDGM payment methodologies, and hospice coding expectations. • Audit clinical charts to identify documentation gaps or inconsistencies, and collaborate with clinical leadership or compliance teams to resolve query needs. • Support revenue cycle efficiency by meeting established productivity and turnaround time goals to prevent delays in billing and claim submissions. • Assist with internal quality assurance and external medical reviews, including TPE, ADRs, and compliance audits. • Collaborate cross-functionally with clinical, QA, compliance, and revenue cycle teams to drive documentation integrity and regulatory readiness.