• Evaluate medical record documentation to ensure diagnostic and procedural code integrity in compliance with ICD-10-CM, CPT-4/HCPCs rules and guidance • Conducts all activities with the highest standards of professionalism and confidentiality • Protecting patients’ rights by maintaining confidentiality of personal, medical and financial information per HIPAA and other federal regulations • Complies with all applicable laws, regulations, policies and procedures, supporting the organization’s corporate integrity efforts by acting in an ethical and appropriate manner • Support the vision, mission and values of Santiam Hospital & Clinics • Provides and maintains a safe environment for caregivers, patients, guests & coworkers • Delivers customer service in a manner that promotes goodwill, is timely, efficient and accurate • May perform additional duties of similar complexity within the organization, as required or assigned

• Reviews medical records and accurately assigns and sequences CPT, ICD-10CM, and HCPCS codes/modifiers • Generates physician queries following established procedures • Performs charge entry of professional services • Maintains required continued education hours

• Read and understand explanations of benefits to perform medical billing functions. • Knowledge of CPT, Modifiers, and ICD-10 codes. • Assure all charges are entered within 24-48 hours of receipt from the physicians/providers. • Make necessary changes to patient accounts (address, name, telephone number, and insurance changes, etc.) • Assure all claims are sent electronically on a daily basis. • Review and work claim edits and rejections on a daily basis. • Paper claims are sent on a weekly basis. • Patient statements are sent on a monthly basis or weekly based on volume. • Post all insurance and patient payments within 24-48 hours of receipt (batched by date of receipt and daily balancing is required). • Work all denials at the time of receipt. • Prepare and send appeals. • Begin insurance follow-up at 31 days for claims. • Answer telephone calls regarding all medical billing inquiries. • Submit copies of overpaid accounts to Billing Manager for review. • Work patient AR based on the practice policy. • Send accounts to collection based on practice policy. • Maintain strictest confidentiality of patient private health information (PHI) by disclosing only information requested. • Handle all electronic processes relating to claims submission, remit posting etc. • All practice records received should be scanned to client folders on the company network drives. • Performs additional duties as requested by upper management.

• Responsible for assignment of accurate E&M, ICD, CPT and HCPCS codes and modifiers from medical record documentation into the Government computer systems • Identifies and abstracts information from medical records (paper or electronic) for special studies and audits, internal and external • Interacts with MTF staff to ensure documentation is clear and supports coding assignments • Educates MTF staff through individual or group in-services and training sessions • Maintains a delinquency report of missing records in order to facilitate completion of work within the required thresholds • Works closely with the Coding Supervisor/auditor during audit process • Ensures all required component parts of the medical record that pertain to coding are present, accurate and compile with DoD and JCAHO requirements • Works with Coding Compliance-Editor software to ensure records are accurately coded • May also be responsible for the assignment of accurate ICD diagnoses, CPT and HCPCS, modifiers, and quantities from medical record documentation (paper or electronic) for inpatient professional services (IPPS encounters - a.k.a, rounds) • Perform focus audits as designated by the MTF • All audit spreadsheets are submitted to the supervisor weekly without discrepancies as required • Submit monthly report on activities done for the month, e.g. audit results, training provided and feedback as required by the MTF • Must attend scheduled coding and auditing meetings and trainings as required by the MTF • Other duties as assigned