Role Description The HIM Certified Coder is responsible for accurate and timely coding of hospital inpatient, hospital outpatient and/or professional fee encounters using appropriate ICD10/ICDPCS, CPT, or HCPCs codes and appropriate coding software such as computer assisted coding and encoders as a means to ensure compliant billing of Carle claims. - Responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. - Responsible for understanding and applying coding knowledge to resolve billing edits related to coding. - Uses Carle electronic medical record systems to review clinical encounters. Qualifications - Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA) - Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA) - Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC) - Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) - Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) - Certified Coding Specialist - Physician-Based (CCS-P) - American Health Information Management Association (AHIMA) - Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA) Requirements - Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. - Provides interdepartmental coding assistance, as needed, to determine accurate coding assignment. - Develops methodology to provide a coding process that is compliant with regulatory agencies including the utilization of reference materials such as, but not limited to, Center for Medicare Services (CMS) publications, Coding Clinic, CPT Assistant, etc. - Facilitates optimization of revenue while maintaining compliance standards for the organization through varied venues and tasks (auditing/monitoring, training, facilitation of charges through the claim scrubber system, assisting with various patient or payor related charge/account inquiries, research on various coding/billing related topics as requested by various sources internal and external to the organization, etc.). - Serves as an expert resource regarding CPT, HCPCS, ICD-10-CM, all other necessary coding systems, and regulatory guidelines for all internal and external parties. - Serve as liaison for coding and billing staff to ensure accurate charge capture. - Reports any documentation and coding improvement needs based upon review findings. - Responsible for maintaining coding certification, knowledge and skills to successfully perform job duties. - Performs provider and peer coding audits as requested. - Assist with monitoring of internal controls for coding and billing. - Facilitates external audit activities and reporting of such activities to the appropriate administrative personnel. Benefits - The compensation range for this position is $23.58 per hour - $39.38 per hour. - The actual compensation offered a candidate will be dependent on a variety of factors including, but not limited to, the candidate’s experience, qualifications, location, training, licenses, shifts worked and compensation model. - Carle Health offers a comprehensive benefits package for team members and providers.

• Prepare and submit billing data and medical claims to insurance companies • Ensure the patient’s medical information is accurate and up to date • Review patient statements • Collect and review referrals and pre-authorizations • Access EMRs to locate patient demographics and insurance information • Call payers to obtain information regarding patient eligibility, authorization, and/or denials • Monitor and record patient payments • Investigate and Appeal denied claims • Work front end rejections and back-end denials • Help patients develop payment plans • Other duties as assigned

• Provide accurate and timely revenue cycle and account management services to OBS member clients • Identify and resolve claims issues, maintaining compliance with payer requirements • Engage in continuous process improvement • Provide high-quality billing and customer service support to member clinics and their patients • Manage self-pay accounts and customer inquiries or processing daily claims production

• serve as the medical coding subject matter expert for Long-Term Care coding workgroups and MMIS project initiatives • review annual and quarterly CPT, HCPCS, and ICD-10 code updates • research and respond to complex medical coding and policy inquiries • lead meetings and facilitate stakeholder discussions • maintain and enhance documentation of coding policies