Explore 10 coder jobs from 2 hiring companies in Gladwin, MI, US. Filter by remote, salary, experience, and company, then open any listing to apply.

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Coder Jobs

Covenant HealthCare

MyMichigan Health

Onsite

Hybrid

Summary:
The coding specialist, utilizing the clinical documentation management program and clinical knowledge, analyzes inpatient and outpatient medical records for completeness of documentation, contacting the appropriate provider for additional documentation if needed. Accurate diagnosis and procedure codes are then assigned based on the documentation in the medical record, which directly impacts the appropriate DRG assignment for reimbursement. Critical data elements are abstracted by the Coding specialist on all inpatient discharges. This information is used by the organization for decision making.

Responsibilities:
(60%)* Assigns accurate ICD-CM diagnosis and procedure codes and CPT codes in a timely manner for all appropriate encounters and ensures appropriate DRG assignment based on the clinical documentation within the medical record by using CMS and American Hospital Guidelines and following AHIMA code of ethics.  (30%)* Utilizes clinical knowledge to interact with the Clinical Documentation Specialists and physicians/providers on a daily basis to assist in improving documentation within the medical record; to accurately reflect the severity of illness and level of care provided.  (10%)* Demonstrates willingness to participate in continuing education to enhance coding knowledge. OTHER DUTIES AND RESPONSIBILITIES: Meets established productivity guidelines.  Other duties as assigned.  MyMichigan Health is a technology driven organization and employees need to demonstrate competency in Microsoft Windows.  An employee may be required to participate in further learning opportunities offered by MyMichigan Health.

Certifications and Licensures:
E/M CODER: CPC, CCS, CCSP, RHIT, OR RHIA Effective October 1, 2013, new hires must be RHIA or RHIT eligible and successfully complete the certification exam within six (6) months of hire and maintain the certification to meet the requirements of the position.  FINGERPRIN: Fingerprinting

Required Education:
Associates degree is required

Other Information:
EXPERIENCE, TRAINING AND SKILLS:Coding experience from an AHIMA approved internship required or successfully completed an independent study program offered by AHIMA. Knowledge of medical terminology and anatomy. Written, oral, organizational and interpersonal skills needed to communicate successfully. PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death. Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position.Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description. Overall vision and hearing is necessary with or without assisted device(s).Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching. Some exposure to blood borne pathogens and other potentially infectious materialAbility to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake.Overall dexterity is required including handling, reaching, grasping, fingering and feeling.  May require repetition of these movements on a regular to frequent basis. Physical Demand Level: Sedentary.  Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.

Coder II

Medical coder with AHIMA internship or RHIA/RHIT eligible; assigns ICD-CM and CPT codes; ensures correct DRG; strong medical terminology knowledge.

Summary:
**Candidates must have a primary address located within the state of Michigan or willing to move to Michigan to be considered.** **Candidate must have Denials experience to be considered** This position is responsible for coding all services including major and minor surgical cases performed in both the office and hospital setting for MyMichigan Medical Group, Family Practice Center and the MyMichigan Urgent Care locations. This position monitors compliance with third party payers guidelines while ensuring the maximum allowed reimbursement is attained. This position requires broad knowledge of current payer rules for all insurance companies we participate with, in addition to analytical skills to ensure all procedures are coded correctly for a timely and accurate reimbursement from all payers. This position must be able to work independently and make decisions based on their broad knowledge of current procedure terminology (CPT) and International Classification of Diseases (ICD) coding rules and regulations.

Responsibilities:
(25%)* Codes visits and services performed in both the office and hospital setting within 48 hours of receipt.  (25%)* Uses the Epic coding edits, CPT Assistant, and Centers for Medicare and Medicaid Services (CMS) coding guidelines to make necessary corrections to ICD, CPT, Healthcare Common Procedure Coding Systems (HCPCS), codes, modifiers and place of service to ensure clean claims. (20%)* Codes all major and minor surgical cases, including obstetrics, performed in both the office and hospital setting, within 48 hours of receipt.  (20%)* Utilizes clinical knowledge to interact with physicians/provider on a regular basis to assist in improving documentation. (10%)* Demonstrates willingness to participate in continuing education to enhance coding knowledge.   OTHER DUTIES AND RESPONSIBILITIES:Reviews accounts related to patient or payer complaints/concerns.  After review, responsible for timely communication to the patient, payer and physician (if needed) to address their concern.  Meets established productivity guidelines.  Other duties as assigned.  MyMichigan Health is a technology driven organization and employees need to demonstrate competency organization in Microsoft Windows.  Employees may be required to participate in further learning opportunities offered by MyMichigan Health.

Certifications and Licensures:
AAPC CPC: AAPC Cert Professional Coder Certified Professional Coder Apprentice - CPC-A will also be accepted. An employee with this certification will need to obtain the Certified Professional Coder certification with in 365 days of hire.  E/M CODER: CPC, CCS, CCSP, RHIT, OR RHIA Certified Professional Coder - Apprentice (CPC-A) will be accepted and will remain for 365 days from time of hire or transfer or until such time, the manager is able to validate apprenticeship has been successfully completed. CPC-Certified Professional Coder, CCS-P Certified Coding Specialist-Physician based, and CCS-Certified Coding Specialsit is also accepted upon hire or transfer to this position. Those hiring in to the position with an either a Registered Health Informaiton Technician (RHIT) or Registered Health Information Administrator (RHIA) degree, will have 6 months from date of hire or transfer test and obtain this respective certification. RHIA: Registered Health Info Analyst RHIT: Reg Health Information Tech FINGERPRIN: Fingerprinting CCS-P: Cert Coding Spec-Phys Based CCS: Certified Coding Specialist

Required Education:
High school diploma or GED is required Associate degree is preferred

Other Information:
EXPERIENCE, TRAINING AND SKILLS:Experience with denials required. Two (2) years physician coding and billing experience and four (4) years experience in the medical field is preferred. One (1) year with direct physician contact is preferred.   Knowledge of medical terminology and anatomy.  Proficiency in the use of personal computer.  Knowledge of medical record/patient confidentiality laws.  Great organizational skills are required.  Oral, written and interpersonal skills needed to communicate successfully with individuals and groups and interact with people at all levels to communicate ideas and concepts in a clear and understandable manner. PHYSICAL/MENTAL REQUIREMENTS AND TYPICAL WORKING CONDITIONS:Exposure to stressful situations, including those involving public contact, as well as, trauma, grief and death. Able to wear personal protective equipment that includes latex materials or appropriate substitute if required for your position. Is able to move freely about facility with or without an assisted device and must be able to perform the functions of the job as outlined in the job description. Overall vision and hearing is necessary with or without assisted device(s). Frequently required to sit/stand/walk for long periods of time. May require frequent postural changes such as stooping, kneeling or crouching. Some exposure to blood borne pathogens and other potentially infectious material. Must follow MyMichigan Health bloodborne pathogen and TB testing as required. Ability to handle multiple tasks, get along with others, work independently, regular and predictable attendance and ability to stay awake. Overall dexterity is required including handling, reaching, grasping, fingering and feeling. May require repetition of these movements on a regular to frequent basis. Physical Demand Level: Sedentary. Must be able to occasionally (0-33% of the workday) lift or carry 0-10 lbs.

Coder I

Coding specialist with denials experience; CPT/ICD coding; Epic knowledge; handles surgical coding; Michigan resident or willing to relocate; CPC certification required.

Overview The Professional Coder provides timely and accurate clinical and administration data to ensure optimal reimbursement for professional services performed at acute care, inpatient, outpatient, urgent care or physician offices to meet organizational needs.  This position is responsible for ICD10CM diagnosis, CPT-4 coding and charge entry related to coding, documentation, billing and reimbursement issues.  Works as a liaison between centralized billing staff, practice managers and office staff and may be required to meet with the office staff and physicians as needed.  This position is responsible for the monitoring the quality of coding and stays current on professional coding changes, compliance issues, billing, documentation, reimbursement and interpretation of coding/documentation rules.  Primary patient contact is only social.He/she demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation. Responsibilities <ul><li>Contributes to organizational success targets for patient satisfaction. </li><li>Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients and other staff members of departments encountered. </li><li>Adhere to coding rules for coding professional services for multiple specialties (such as; neurosurgery, pediatric surgery, rehab, orthopedic, cardiology, etc.), urgent care, occupational health, family practice and other to ensure quality coding based upon documentation within the patient record. </li><li>Follows policies, procedures and guidelines to assure consistent coding quality.  At the same time utilizes analytical skills when reviewing charts, interpreting documentation and applying codes, sufficing edits, etc. </li><li>Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe.  This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur. </li><li>Participates in HIM department meetings and area specific meetings (Professional coding, Practice Managers, billing, routine specialty, clinical areas, resident/physician meetings, etc.) as required. </li><li>Assist in achieving departmental, AR and area specific goals. </li><li>Charge entry for professional services (office and/or hospital based for acute care, urgent care, specialty care, occupational health, skilled nursing, et. Services). </li><li>Supports physicians, leadership, managers and staff on coding and documentation related items.  Problem solves, researches topics, make recommendations and provides education as needed. </li><li>Ability to develop training or educations materials. </li><li>Performs E & M, procedural or other specified coding audits for many professional settings and services. </li><li>Helps to identify solutions to problems and assists in resolving issues related to coding. </li><li>Shares knowledge during training of new staff and is a resource to others. </li><li>Independent learning with desire for continued personal and professional growth.  Stays current on coding updates and publications. </li><li>Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed. </li><li>Maintains professional credentials. </li><li>Required to provide written and oral feedback to providers on audits, for education, or other as required. </li><li>Must be professional, self-motivated, and work independently with the ability to make sound decisions, analyze issues and solve problems. </li><li>Assist CBO/Finance/Data/CMG/ Other as requested for follow up on items related to coding, billing or reimbursement. </li><li>Assure that all legal requirements, including Federal (HIPAA) and State regulations are met. </li><li>Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and Department Policies and Procedures. </li><li>Participates in development and attainment of department and workgroup goals. </li><li>Perform other duties as assigned which may include: working with students, develop policies, guidelines or other documents in order to facility complete and timely gathering of information for clinical, billing or coding.</li></ul> Qualifications EDUCATION/EXPERIENCECertified Professional Coder (CPC) required or Associates Degree/Certification in medical curriculum with two years coding experience in a professional setting.  May substitute two years ICD9/10CM and CPT-4 coding experience with understanding that the Certified Professional Coder (CPC) requirement be fulfilled within 12 months of the start date.Experience in professional coding setting/physician office setting preferred.Coding experiences preferred utilizing ICD9/10CM and CPT-4 coding books and references in a professional setting.Must be able to tolerate working under stress, limited time constraints and with frequent interruptions and deadlines.Prefers 2 years’ experience in interpreting professional/physician remittance advice statements for all major insurance payers for multiple physician specialties. KNOWLEDGE/SKILLS/ABILITIES<ul><li>Basic computer skills including the ability to search for work related items on line using the internet.</li><li>Knowledge of standard office equipment.</li><li>Knowledge of computer use including EMR, email/Lotus Notes/Outlook, internet, and other software as needed (Word, Excel, Intelicode, Systoc, AAPC, etc.).</li><li>Knowledge/understanding of medical terminology and anatomy.</li><li>Knowledge of third party payer coding and billing reimbursement.</li><li>Knowledge of ICD9/10CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines.</li><li>Demonstrates effective communication methods and skills, both verbally and in writing.   </li><li>Uses appropriate organization/priority setting skills to complete work timely and accurately.</li><li>Practices effective problem identification and resolution skills as a method of sound decision making.</li><li>Demonstrates interpersonal skills required to work with many other people and personalities.</li><li>Requires the ability to use sound judgement, based upon the latest guidelines, federal and state statutes and regulations, as well as hospital and departmental policies.</li><li>Continued growth in many areas.</li><li>Ability to sit and look at computer screen for long periods of time.</li><li>Ability to be flexible to adjust assignments as priorities change.</li></ul>WORKING CONDITIONS/PHYSICAL DEMANDS<ul><li>Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.</li><li>Constant sitting, use of hands to finger, handle and feel.</li><li>Constant hearing and near vision.</li><li>Frequent depth perception, midrange and far vision.</li><li>Frequent color and field of vision.</li><li>Frequent lifting 0-10 lbs.</li><li>Occasional lifting 11-50 lbs.</li><li>Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.</li><li>Occasional twisting, reaching and talking. ICIMCHNonNJ </li></ul>

PROFESSIONAL CODER

Professional Coder

CPC required or Associates Degree/Certification with two years professional coding experience; CPC within 12 months if substitute ICD9/10/CPT-4 experience.

Overview The Health Information Management Coder Inpatient Level 2 provides timely and accurate clinical and administration data to ensure optimal reimbursement for inpatient, rehab and/or skilled nursing coding to support the facility needs. Primary patient contact is only social.Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to providing Extraordinary Care for Every Generation.   Responsibilities <ul><li>Contributes to organization success targets for patient satisfaction.</li><li>Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other department staff members.</li><li>Adheres to current coding rules, regulations and requirements for inpatient coding, DRG/APR-DRG assignment, rehab coding, skilled care coding, CMG assignment, IRFPAI completion, inpatient coding CCI edits, POA assignment and other to ensure quality coding based upon documentation within the patient record.</li><li>Codes all inpatient charts varying from neonatal to geriatric, medical, surgical, critical care, and trauma.</li><li>Performs a thorough review of all clinical information to identify the principal diagnosis, secondary diagnoses, procedures, comorbid conditions and complications and the impact of clinical documentation that lead to a final DRG/APR-DRG assignment. When documentation is conflicting or unclear, a retrospective query will be sent to providers to assure correct assignment of codes and final DRG. Coders may also identify missed concurrent query opportunities and follow up accordingly by providing detailed feedback and justification including clinical picture, coding guidelines, coding references, etc.</li><li>Follows policies, procedures, and guidelines to assure consistent coding quality. At the same time, utilizes analytical skills when reviewing charts, interpreting documentation, and applying codes, DRG’s, sufficing edits, etc.</li><li>Supports concurrent Clinical Documentation Program by completing chart reviews and entering information in CDI software, works closely with and often directs the CDS staff to ensure optimal DRG, APR DRG, and documentation. Compares the CDI working DRG on CDI charts to the final Coder DRG. Shares knowledge with CDI’s regarding the accuracy of the clinical documentation that lead to the final DRG assignment.</li><li>May also be required to work with external vendors/customers on issues, audits, or projects.</li><li>Helps to identify solutions to problems and assists in resolving issues.</li><li>Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur.</li><li>Participates in HIM department meetings and area specific meetings (IPC, IPC/CDS, clinical areas, resident/physician meetings, etc.) as required.</li><li>Assist in achieving departmental, AR and area specific goals.</li><li>Participates in identifying lean opportunities to enhance coding efficiency and lower AR.</li><li>Shares knowledge during training of new staff and is a resource to others.</li><li>Independent learning with desire for continues personal and professional growth. Stays current on coding updates such as Coding Clinics, code updates/changes.</li><li>Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.</li><li>Maintains professional credentials.</li><li>Assist CBO/Finance/Data/CMG/ Patient Safety and Quality/Other as requested for follow up on items related to coding, billing, reimbursement, and State reporting/other. Assure that all legal requirements, including federal (HIPAA) and Ate regulations are followed.</li><li>Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and department policies and procedures.</li><li>Participates in the development and attainment of department and workgroup goals.</li><li>Performs other duties as assigned which may include reviewing, analyzing coding denials, denial appeals, denial entry, writing appeal letters to outside agencies, coding quality reviews, training of new staff, mentoring students, or testing for new software upgrades.</li><li>Help develop or maintain guidelines, procedures, or policies.  </li></ul> Qualifications EDUCATION/EXPERIENCE REQUIREMENTSRHIA, RHIT, or CCS credential required.Eligible Bachelor or Associate Degree graduates will be considered with the expectation they pass the national exam.Acute care inpatient coding experience preferred (inpatient diagnosis, inpatient procedures coding utilizing ICD10CM/ICD10PCS coding books and references).Clinical documentation knowledge for inpatient coding strongly preferred. KNOWLEDGE/SKILLS/ABILITIES<ul><li>Basic computer skills.</li><li>Must be able to tolerate working under stress, limited constraints and with frequent interruptions and deadlines.</li><li>Knowledge of standard office equipment.</li><li>Knowledge of computer use including EMR, email/Outlook, internet, 3M encoder and other software as needed (Lawson, Word, Excel).</li><li>Demonstrates effective communication methods and skills, both verbally and in writing.</li><li>Uses appropriate organization/priority setting skills to complete work timely and accurately.</li><li>Practices effective problem identification and resolutions skills as a method of sound decision making.</li><li>Demonstrates interpersonal skills required to work with many other people and personalities.</li><li>Ability to use sound judgement, based upon the latest guidelines, federal and state statutes, and regulations, as well as hospital and departmental policies.</li><li>Ongoing professional growth in many areas.</li><li>Ability to sit and look at computer screen for long periods of time.</li><li>Ability to be flexible to adjust assignments as priorities change.</li></ul>WORKING CONDITIONS/PHYSICAL REQUIREMENTS<ul><li>Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.</li><li>Constant sitting, use of hands to finger, handle and feel.</li><li>Constant hearing and near vision.</li><li>Frequent depth perception, midrange and far vision.</li><li>Frequent color and field of vision.</li><li>Frequent lifting 0-10lbs.</li><li>Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.</li><li>Occasional twisting, reaching and talking.</li><li>Occasional lifting 11-50lbs.  ICIMCHNonNJ </li></ul>

INPATIENT CODER (OCCASIONAL ONSITE REQUIRED)

Inpatient Coder

RHIA/RHIT/CCS credential required; bachelor or associate degree graduates considered if pass national exam; inpatient coding experience preferred; ICD-10-CM/PCS knowledge.

Overview The Health Information Management Coding Specialist Outpatient provides timely and accurate clinical and administration data to ensure optimal reimbursement for facility outpatient, ambulatory surgery, observation, recurring accounts to support the facility coding needs. This may include coverage on some Rehab or Skilled Care accounts. Primary patient contact is only social. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to providing Extraordinary Care for Every Generation. Responsibilities Contributes to organization success targets for patient satisfaction. Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other department staff members. Adhere to coding rules for outpatient coding, APC assignment, outpatient coding CCI edits and other to ensure quality coding based upon documentation with the patient record. May also code skilled care or rehab services with involves CMG assignment and IRFPAI completion. Follows policies, procedures, and guidelines to assure consistent coding quality. At the same time, utilizes analytical skills when reviewing charts, interpreting documentation, and applying codes, sufficing edits, reviewing pertinent charges, etc. Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur. Participates in HIM department meetings and area specific meetings (OPC, charge master, clinical areas, resident/physician meetings, etc.) as required. Assist in achieving departmental, AR and area specific goals. May also be required to work with external vendors/customers on issues, audits, or projects. Helps to identify solutions to problems and assists in resolving issues. Participates in identifying lean opportunities to enhance coding efficiency and lower AR. Shares knowledge during training of new staff and is a resource to others. Independent learning with desire for continued personal and professional growth. Stays current on coding updates such as Coding Clinics, code updates/changes. Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed. Maintains professional credentials. Assist CBO/Finance/Data/CMG/Patient Safety and Quality/Other as requested for follow up on items related to coding, billing, reimbursement. Assure that all legal requirements, including Federal (HIPAA) and State regulations are followed. Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and department policies and procedures. Participates in the development and attainment of department and workgroup goals. Performs other duties as assigned which may include reviewing, analyzing coding denials, denial appeals, denial entry, writing appeal letters to outside agencies, coding quality reviews, training of new staff, mentoring students, or testing for new software upgrades. Help develop or maintain guidelines, procedures, or policies. Qualifications EDUCATION/EXPERIENCE REQUIREMENTS RHIA, RHIT, or CCS credential required. Eligible Bachelor or Associate Degree graduates will be considered with the expectation they pass the national exam. Acute care outpatient coding experience preferred (diagnosis and procedural coding utilizing ICD10CM and CPT-4 coding books and references including NCCI edits or modifiers). Clinical documentation knowledge of outpatient coding preferred.  KNOWLEDGE/SKILLS/ABILITIES Basic computer skills. Must be able to tolerate working under stress, limited constraints and with frequent interruptions and deadlines. Knowledge of standard office equipment. Knowledge of computer use including EMR, email/Outlook, internet, encoder, and other software as needed (Vital Ware, Lawson, Excel). Demonstrates effective communication methods and skills, both verbally and in writing. Uses appropriate organization/priority setting skills to complete work timely and accurately. Practices effective problem identification and resolutions skills as a method of sound decision making. Demonstrates interpersonal skills required to work with many other people and personalities. Ability to use sound judgement, based upon the latest guidelines, federal and state statutes, and regulations, as well as hospital and departmental policies. Ongoing professional growth in many areas. Ability to sit and look at computer screen for long periods of time. Ability to be flexible to adjust assignments as priorities change.  WORKING CONDITIONS/PHYSICAL REQUIREMENTS Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards. Constant sitting, use of hands to finger, handle and feel. Constant hearing and near vision. Frequent depth perception, midrange and far vision. Frequent color and field of vision. Frequent lifting 0-10lbs. Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling. Occasional twisting, reaching and talking. Occasional lifting 11-50lbs.

OUTPATIENT CODER (OCCASIONAL ONSITE REQUIRED)

Outpatient Coder

RHIA/RHIT/CCS credential required; eligible Bachelor or Associate; outpatient coding experience; ICD-10-CM/CPT-4; EMR, Excel; strong communication.

CERTIFIED PROFESSIONAL CODER - ORTHOPEDICS, ONSITE

Certified Professional Coder

CPC required or Associates Degree/Certification with two years coding experience; may substitute ICD9/10CM and CPT-4 experience; knowledge of medical terminology; experience in professional/physician coding preferred.

Overview:
The Health Information Management Coder Inpatient Level 2 provides timely and accurate clinical and administration data to ensure optimal reimbursement for inpatient, rehab and/or skilled nursing coding to support the facility needs. Primary patient contact is only social.Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to providing Extraordinary Care for Every Generation.  

Responsibilities:
<ul><li>Contributes to organization success targets for patient satisfaction.</li><li>Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other department staff members.</li><li>Adheres to current coding rules, regulations and requirements for inpatient coding, DRG/APR-DRG assignment, rehab coding, skilled care coding, CMG assignment, IRFPAI completion, inpatient coding CCI edits, POA assignment and other to ensure quality coding based upon documentation within the patient record.</li><li>Codes all inpatient charts varying from neonatal to geriatric, medical, surgical, critical care, and trauma.</li><li>Performs a thorough review of all clinical information to identify the principal diagnosis, secondary diagnoses, procedures, comorbid conditions and complications and the impact of clinical documentation that lead to a final DRG/APR-DRG assignment. When documentation is conflicting or unclear, a retrospective query will be sent to providers to assure correct assignment of codes and final DRG. Coders may also identify missed concurrent query opportunities and follow up accordingly by providing detailed feedback and justification including clinical picture, coding guidelines, coding references, etc.</li><li>Follows policies, procedures, and guidelines to assure consistent coding quality. At the same time, utilizes analytical skills when reviewing charts, interpreting documentation, and applying codes, DRG’s, sufficing edits, etc.</li><li>Supports concurrent Clinical Documentation Program by completing chart reviews and entering information in CDI software, works closely with and often directs the CDS staff to ensure optimal DRG, APR DRG, and documentation. Compares the CDI working DRG on CDI charts to the final Coder DRG. Shares knowledge with CDI’s regarding the accuracy of the clinical documentation that lead to the final DRG assignment.</li><li>May also be required to work with external vendors/customers on issues, audits, or projects.</li><li>Helps to identify solutions to problems and assists in resolving issues.</li><li>Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur.</li><li>Participates in HIM department meetings and area specific meetings (IPC, IPC/CDS, clinical areas, resident/physician meetings, etc.) as required.</li><li>Assist in achieving departmental, AR and area specific goals.</li><li>Participates in identifying lean opportunities to enhance coding efficiency and lower AR.</li><li>Shares knowledge during training of new staff and is a resource to others.</li><li>Independent learning with desire for continues personal and professional growth. Stays current on coding updates such as Coding Clinics, code updates/changes.</li><li>Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed.</li><li>Maintains professional credentials.</li><li>Assist CBO/Finance/Data/CMG/ Patient Safety and Quality/Other as requested for follow up on items related to coding, billing, reimbursement, and State reporting/other. Assure that all legal requirements, including federal (HIPAA) and Ate regulations are followed.</li><li>Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and department policies and procedures.</li><li>Participates in the development and attainment of department and workgroup goals.</li><li>Performs other duties as assigned which may include reviewing, analyzing coding denials, denial appeals, denial entry, writing appeal letters to outside agencies, coding quality reviews, training of new staff, mentoring students, or testing for new software upgrades.</li><li>Help develop or maintain guidelines, procedures, or policies.  </li></ul>

Qualifications:
EDUCATION/EXPERIENCE REQUIREMENTSRHIA, RHIT, or CCS credential required.Eligible Bachelor or Associate Degree graduates will be considered with the expectation they pass the national exam.Acute care inpatient coding experience preferred (inpatient diagnosis, inpatient procedures coding utilizing ICD10CM/ICD10PCS coding books and references).Clinical documentation knowledge for inpatient coding strongly preferred. KNOWLEDGE/SKILLS/ABILITIES<ul><li>Basic computer skills.</li><li>Must be able to tolerate working under stress, limited constraints and with frequent interruptions and deadlines.</li><li>Knowledge of standard office equipment.</li><li>Knowledge of computer use including EMR, email/Outlook, internet, 3M encoder and other software as needed (Lawson, Word, Excel).</li><li>Demonstrates effective communication methods and skills, both verbally and in writing.</li><li>Uses appropriate organization/priority setting skills to complete work timely and accurately.</li><li>Practices effective problem identification and resolutions skills as a method of sound decision making.</li><li>Demonstrates interpersonal skills required to work with many other people and personalities.</li><li>Ability to use sound judgement, based upon the latest guidelines, federal and state statutes, and regulations, as well as hospital and departmental policies.</li><li>Ongoing professional growth in many areas.</li><li>Ability to sit and look at computer screen for long periods of time.</li><li>Ability to be flexible to adjust assignments as priorities change.</li></ul>WORKING CONDITIONS/PHYSICAL REQUIREMENTS<ul><li>Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards.</li><li>Constant sitting, use of hands to finger, handle and feel.</li><li>Constant hearing and near vision.</li><li>Frequent depth perception, midrange and far vision.</li><li>Frequent color and field of vision.</li><li>Frequent lifting 0-10lbs.</li><li>Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling.</li><li>Occasional twisting, reaching and talking.</li><li>Occasional lifting 11-50lbs.  </li></ul>

RHIA/RHIT/CCS credential required; eligible Bachelor or Associate graduates considered with exam pass; inpatient coding experience preferred; knowledge of ICD-10-CM/ICD-10-PCS; CDI knowledge helpful.

Overview:
The Health Information Management Coding Specialist Outpatient provides timely and accurate clinical and administration data to ensure optimal reimbursement for facility outpatient, ambulatory surgery, observation, recurring accounts to support the facility coding needs. This may include coverage on some Rehab or Skilled Care accounts. Primary patient contact is only social. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to providing Extraordinary Care for Every Generation.

Responsibilities:
Contributes to organization success targets for patient satisfaction. Formulates and uses effective working relationships with all members of the HIM department, physicians, external customers, patients, and other department staff members. Adhere to coding rules for outpatient coding, APC assignment, outpatient coding CCI edits and other to ensure quality coding based upon documentation with the patient record. May also code skilled care or rehab services with involves CMG assignment and IRFPAI completion. Follows policies, procedures, and guidelines to assure consistent coding quality. At the same time, utilizes analytical skills when reviewing charts, interpreting documentation, and applying codes, sufficing edits, reviewing pertinent charges, etc. Assures coding is completed timely and all work queues are maintained at a reasonable completion rate/turnaround timeframe. This includes the willingness to help others, accepting help from others and the ability to work extra when backlogs occur. Participates in HIM department meetings and area specific meetings (OPC, charge master, clinical areas, resident/physician meetings, etc.) as required. Assist in achieving departmental, AR and area specific goals. May also be required to work with external vendors/customers on issues, audits, or projects. Helps to identify solutions to problems and assists in resolving issues. Participates in identifying lean opportunities to enhance coding efficiency and lower AR. Shares knowledge during training of new staff and is a resource to others. Independent learning with desire for continued personal and professional growth. Stays current on coding updates such as Coding Clinics, code updates/changes. Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed. Maintains professional credentials. Assist CBO/Finance/Data/CMG/Patient Safety and Quality/Other as requested for follow up on items related to coding, billing, reimbursement. Assure that all legal requirements, including Federal (HIPAA) and State regulations are followed. Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and department policies and procedures. Participates in the development and attainment of department and workgroup goals. Performs other duties as assigned which may include reviewing, analyzing coding denials, denial appeals, denial entry, writing appeal letters to outside agencies, coding quality reviews, training of new staff, mentoring students, or testing for new software upgrades. Help develop or maintain guidelines, procedures, or policies.

Qualifications:
EDUCATION/EXPERIENCE REQUIREMENTS RHIA, RHIT, or CCS credential required. Eligible Bachelor or Associate Degree graduates will be considered with the expectation they pass the national exam. Acute care outpatient coding experience preferred (diagnosis and procedural coding utilizing ICD10CM and CPT-4 coding books and references including NCCI edits or modifiers). Clinical documentation knowledge of outpatient coding preferred.  KNOWLEDGE/SKILLS/ABILITIES Basic computer skills. Must be able to tolerate working under stress, limited constraints and with frequent interruptions and deadlines. Knowledge of standard office equipment. Knowledge of computer use including EMR, email/Outlook, internet, encoder, and other software as needed (Vital Ware, Lawson, Excel). Demonstrates effective communication methods and skills, both verbally and in writing. Uses appropriate organization/priority setting skills to complete work timely and accurately. Practices effective problem identification and resolutions skills as a method of sound decision making. Demonstrates interpersonal skills required to work with many other people and personalities. Ability to use sound judgement, based upon the latest guidelines, federal and state statutes, and regulations, as well as hospital and departmental policies. Ongoing professional growth in many areas. Ability to sit and look at computer screen for long periods of time. Ability to be flexible to adjust assignments as priorities change.  WORKING CONDITIONS/PHYSICAL REQUIREMENTS Ability to maintain regular, punctual attendance consistent with the ADA, FMLA and other federal, state and local standards. Constant sitting, use of hands to finger, handle and feel. Constant hearing and near vision. Frequent depth perception, midrange and far vision. Frequent color and field of vision. Frequent lifting 0-10lbs. Occasional standing, walking, carrying, pushing, pulling, climbing, balancing, stooping, kneeling, crouching, squatting and crawling. Occasional twisting, reaching and talking. Occasional lifting 11-50lbs.

RHIA/RHIT or CCS credential required; eligible Bachelor/Associate graduates considered; outpatient coding experience preferred; ICD-10-CM and CPT-4 knowledge.

Overview:
The Denials Specialist is responsible for investigating and resolving denied insurance claims, ensuring timely resolution and optimal reimbursement for professional services performed at outpatient, urgent care or physician offices at Covenant HealthCare. This position will monitor and analyze quality of coding, compliance issues, billing, documentation and reimbursement and interpretation. Demonstrates excellent customer service performance in that his/her attitude and actions are at all times consistent with the standards contained in the Vision, Mission and Values of Covenant HealthCare and the commitment to Extraordinary Care for Every Generation.

Responsibilities:
 - Analyze denied claims by identifying reasons for denial and verify claim information against payer policies and contracts.  - Resolve denials by determining appropriate actions and submitting appeals within specified deadlines.  - Compile supporting documentation and evidence to strengthen appeal cases, and maintain accurate records of denial reasons, actions taken, and outcomes.  - Generate reports on denial trends, root causes, and appeal success rates, providing insights and recommendations for process improvements to reduce future denials.  - Follows policies, procedures and guidelines to assure consistent coding quality. At the same time utilizes analytical skills when reviewing charts, interpreting documentation and applying codes, sufficing edits, etc. - Provide training and support to internal teams on denial prevention strategies and best practices, serving as a subject matter expert on denial management processes and payer requirements. - Utilizes numerous references to support technical decisions, clinical understanding of disease processes or procedures/tests performed. - Adhere to coding rules for coding professional services for multiple specialties. - Assure that all legal requirements, including Federal (HIPAA) and State regulations are met. - Demonstrates an awareness of legal/confidentiality issues and adheres to all HIPAA Privacy and Security and Department Policies and Procedures. - Participates in development and attainment of department and workgroup goals. - Contributes to organizational success targets for patient satisfaction. - Perform other duties as assigned.

Qualifications:
EDUCATION/EXPERIENCE - Associate's degree in medical coding curriculum required. - Experience in professional coding setting/physician office setting and interpreting professional/physician remittance advice statements for all major insurance payers for multiple physician specialties preferred. - Certified Professional Coder (CPC) required and/or must be completed within 12 months of the start date. KNOWLEDGE/SKILLS/ABILITIES - Knowledge of office equipment and computer use including EMR, Microsoft Outlook, Excel, Word, and other software, as needed (Intelicode, Systoc, AAPC, etc.). - Knowledge/understanding of medical terminology and anatomy. - Knowledge of third-party payer coding and billing reimbursement. - Knowledge of ICD9/10CM diagnosis coding, CPT-4 coding and HCPCS coding guidelines. - Demonstrates effective communication methods and skills, both verbally and in writing. - Uses appropriate organization/priority setting skills to complete work timely and accurately. - Practices effective problem identification and resolution skills as a method of sound decision making. - Demonstrates interpersonal skills required to work with many other people and personalities. - Requires the ability to use sound judgement, based upon the latest guidelines, federal and state statutes and regulations, as well as hospital and departmental policies. - Ability to sit and look at computer screen for long periods of time. - Ability to be flexible to adjust assignments as priorities change. WORKING CONDITIONS/PHYSICAL DEMANDS - Ability to maintain punctual attendance consistent with ADA, FMLA, and other federal, state, and local standards. - Constant sitting, talking, hearing, near vision, and midrange vision. - Occasional lifting up to 25 lbs. - Frequent depth perception, visual accommodation, and color vision. - Occasional standing, walking, twisting, reaching, feeling, and field of vision. - Must be able to sit and type for long periods of time. - Must be able to use the telephone for long periods of time.

DENIALS SPECIALIST

Denials Specialist

Associate degree in medical coding; CPC certification; experience in professional coding; knowledge of ICD-9/10, CPT-4, HCPCS; EMR, MS Office; strong communication and problem-solving skills.

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