Explore 7 coder jobs from 2 hiring companies in Maroa, IL, US. Filter by remote, salary, experience, and company, then open any listing to apply.

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Coder Jobs

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Overview:
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. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters.

Responsibilities:
Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
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 successfuly 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.

Qualifications:
Certifications: 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); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Education: , Work Experience: 

Carle Health Company Overview:
Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.   We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range:
The compensation range for this position is $23.58per hour - $39.38per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

HIM Cert Coder IP - CFH

HIM Coder

Certified CPC/COC/CIC/CCS-P/CCS/RHIT/RHIA with ICD-10-CM/PCS, CPT/HCPCS knowledge; experience with coding software and regulatory guidelines.

Overview:
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. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters.

Responsibilities:
Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
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 successfuly 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.

Qualifications:
Certifications: 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); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Education: , Work Experience: 

Carle Health Company Overview:
Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.  We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range:
The compensation range for this position is $23.58per hour - $39.38per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

Certified professional coder with inpatient/outpatient coding experience; knowledge of ICD-10-CM/PCS, CPT/HCPCS, and regulatory guidelines; strong auditing and liaison skills.

Overview:
This position is responsible for timely and accurate quality review of both internal and vendor coding team members to assure compliance with coding guidelines and standards in addition to their foundation coding responsibilities. The position performs quality checks on coding and provides feedback to coders to assure the timely and accurate coding of medical charts for billing. This position also reviews and response to coding-based denials for inpatient, hospital outpatient and professional fee claims and advises leadership on trends related to denials. In collaboration with HIM coding management, the coder/quality review analyst will assist with selection of coders and encounters to be reviewed, as well as education to be presented to the coder based on review outcomes. The coder/quality review analyst will also bring forward any issues related to documentation or systems as they are discovered during the review process. This position participates in the onboarding process of new coders, which may require intensive audits and reviews until the coder is fully trained and released.

Responsibilities:
Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards
Shares results of quality reviews to HIM Leadership with recommendations for education and training
Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors
Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews
Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership
Review and respond to coding denials and coding questions as requested or assigned and performs clinical validation of appeal letters as needed. Assists in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered.
Participates in system and new application testing as needed
Review and resolve coding-based denials using EPIC WQs or other software. Provide denial trending data to leadership as requested
Works with Manager to analyze denied claims and identify trends for education.
Serves as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments.
Provides regular reports to management on denial trends, appeal outcomes and overall performance metrics.
Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards

Qualifications:
Certifications: Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC); Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA); Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Certified Professional Coder - Payer (CPC-P) - American Academy of Professional Coders (AAPC); Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC), Education: , Work Experience: Coding

Carle Health Company Overview:
Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.   We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com.

Salary Range:
The compensation range for this position is $24.28per hour - $40.55per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

HIM Cert Coder/Quality Review Analyst OP Team A

HIM Cert Coder/Quality Review Analyst

Certified coders with CPC/CCA/CCS/RHIA/RHIT/CPC-P, CPCH; knowledge of coding guidelines; experience with audits and denial reviews.

Overview 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. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters. Qualifications Certifications: 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); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Education: , Work Experience: Responsibilities Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
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 successfuly 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. About Us Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.   We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $23.58per hour - $39.38per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

HIM Cert Coder IP

Certifications: CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA. Inpatient/outpatient coding experience; knowledge of ICD-10, CPT, HCPCS; regulatory guidelines.

Overview 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. HIM Certified Coder is responsible for understanding and applying all regulatory coding guidelines, such as National and Local Coverage Determinations and application of CPT modifiers. HIM Certified Coder is also responsible for understanding and applying coding knowledge to resolve billing edits related to coding. HIM coder uses Carle electronic medical record systems to review clinical encounters. Qualifications Certifications: 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); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA), Education: , Work Experience: Responsibilities Responsible for accurately coding all records according to the appropriate coding classification (ICD-10 and/or CPT and/or HCPCs and modifiers) system. The assignment of codes will accurately reflect the diagnoses and procedures pertinent to the patient.
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 successfuly 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. About Us Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.  We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $23.58per hour - $39.38per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

HIM Certified Coder

Certifications: CPC, COC, CIC, CCS-P, CCS, RHIT, RHIA. Inpatient/outpatient coding experience.

Overview This position is responsible for timely and accurate quality review of both internal and vendor coding team members to assure compliance with coding guidelines and standards in addition to their foundation coding responsibilities. The position performs quality checks on coding and provides feedback to coders to assure the timely and accurate coding of medical charts for billing. This position also reviews and response to coding-based denials for inpatient, hospital outpatient and professional fee claims and advises leadership on trends related to denials. In collaboration with HIM coding management, the coder/quality review analyst will assist with selection of coders and encounters to be reviewed, as well as education to be presented to the coder based on review outcomes. The coder/quality review analyst will also bring forward any issues related to documentation or systems as they are discovered during the review process. This position participates in the onboarding process of new coders, which may require intensive audits and reviews until the coder is fully trained and released. Qualifications Certifications: Certified Professional Coder (CPC) - American Academy of Professional Coders (AAPC); Certified Coding Associate (CCA) - American Health Information Management Association (AHIMA); Certified Coding Specialist (CCS) - American Health Information Management Association (AHIMA); Registered Health Information Administrator (RHIA) - American Health Information Management Association (AHIMA); Registered Health Information Technician (RHIT) - American Health Information Management Association (AHIMA); Certified Professional Coder - Payer (CPC-P) - American Academy of Professional Coders (AAPC); Certified Professional Coder - Hospital (CPCH) - American Academy of Professional Coders (AAPC), Education: , Work Experience: Coding Responsibilities Perform accurate and timely quality reviews of internal and vendor coding team members using appropriate code sets and coding guidelines.
Develop and perform timely coding education to internal and vendor coding team members on coding systems, coding standards, protocols and Carle coding workflow as required based on quality review outcomes.
Perform as a production coder when needed in a manner aligned with current coding productivity and quality standards
Shares results of quality reviews to HIM Leadership with recommendations for education and training
Works with HIM leadership to determine frequency and scope of coding quality reviews for specific coders and vendors
Compile and track statistics related to the review function, completed quality reviews, and follow up from those reviews
Identifies coder training needs, system issues, and/or documentation issues and reports them timely to HIM leadership
Review and respond to coding denials and coding questions as requested or assigned and performs clinical validation of appeal letters as needed. Assists in editing appeal letters ensuring clinical documentation support and regulatory guidelines are considered.
Participates in system and new application testing as needed
Review and resolve coding-based denials using EPIC WQs or other software. Provide denial trending data to leadership as requested
Works with Manager to analyze denied claims and identify trends for education.
Serves as subject matter expert (SME) for coding denials providing guidance and education to coding staff, physicians and other hospital departments.
Provides regular reports to management on denial trends, appeal outcomes and overall performance metrics.
Identifies work types to be reviewed based on the coding scope and new coder onboarding needs of the HIM department Develops and performs HIM coding team member group education on coding topics identified during quality reviews and denial reviews Assist the HIM coding management in assuring all coding performed by HIM or HIM vendors meets department standards About Us Find it here.Discover the job, the career, the purpose you were meant for. At Carle Health, we're committed to fostering a workplace where every team member feels valued, respected and empowered, where passion and purpose come together to positively impact the lives of our patients and our communities. Find it all at Carle Health. Our nearly 17,000 team members and providers work together to support patient care across central and southeastern Illinois.  We’ve grown to include eight, award-winning hospitals and a multispecialty provider group with more than 1,500 doctors and advanced practice providers. We’re developing the next generation of providers and healthcare professionals through Carle Illinois College of Medicine, the world’s first engineering-based medical school, and Methodist College. Carle BroMenn Medical Center, Carle Foundation Hospital, Carle Health Methodist Hospital, Carle Health Proctor Hospital, Carle Health Pekin Hospital, and Carle Hoopeston Regional Health Center hold Magnet® designations, the nation’s highest honor for nursing care. We offer opportunities in several communities throughout central Illinois with potential for growth and life-long careers at Carle Health.   We are an Equal Opportunity Employer and do not discriminate against any employee or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class. Carle Health participates in E-Verify and may provide the Social Security Administration and, if necessary, the Department of Homeland Security with information from each new employee's Form I-9 to confirm work authorization. | For more information: human.resources@carle.com. Compensation and Benefits The compensation range for this position is $24.28per hour - $40.55per hour. This represents a good faith minimum and maximum range for the role at the time of posting by Carle Health. 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. To learn more visit careers.carlehealth.org/benefits.

HIM Coder / Quality Review Analyst

Certifications: CPC, CCA, CCS, RHIA, RHIT, CPC-P, CPCH; coding experience; familiarity with coding denials and EPIC workflows.

<h2>About the Department</h2>This position has the primary function of coordinating and supporting the Deputy Chief Compliance Officer with administrative, analytical, and program coordination activities. This position will provide support related to compliance auditing activities and programs, assisting with developing and coordinating the Compliance Audit Plan, supporting proactive and reactive audits of professional fee billings in clinic and facility settings, including federally qualified health centers. Proactively support audit activities related to billing and coding risks to the SOM, identifying and calculating potential overpayments based on audit results, participating in the repayment process if necessary, reviewing research billing compliance issues and assisting the Deputy Chief Compliance Officer in designing and managing a comprehensive billing/auditing program.&nbsp;The position supports compliance-related activities by gathering information, coordinating documentation reviews, monitoring follow-up actions, and preparing materials under the direction of the Deputy Chief Compliance Officer. This role does not independently determine compliance findings or regulatory interpretations, but works within established guidance and supervisory direction.This position will administratively report to the Deputy Chief Compliance Officer who reports to the Chief Compliance Officer who reports to the Dean and Provost of the SOM. &nbsp;This position will work closely with the other staff members in the Office of Compliance and Ethics, academic and administrative departments/ units of the SOM and SIU HealthCare. &nbsp;<h2>Position Duties</h2>Administration: &nbsp;100%<ol style="margin-bottom: 3pt;"><li>Assist with the development and execution of the Annual Compliance Audit Plan as part of the Annual Compliance Work Plan. Identify areas of regulatory audit risk based on regulatory guidance and industry enforcement trends. Track audit schedules, maintain documentation, and support audit logistics.</li></ol><ol start="2" style="margin-bottom: 3pt;"><li>Audit clinical services based on standardized coding systems such as CPT/HCPC billing codes or ICD-10 diagnosis codes under established protocols and supervisory direction.</li><li>Apply Medicare, Medicaid, and third-party payer rules and regulations, sub-regulatory guidance, and when conducting chart reviews, billing audits, or providing guidance to SOM staff; escalating questions or concerns to the Deputy Chief Compliance Officer as appropriate.</li><li>Conduct proactive and reactive audits to confirm adequacy of the documentation relative to billing compliance requirements.</li></ol><ol start="5" style="margin-bottom: 3pt;"><li>Prepare written audit report and assist in the development of training and education for Patient Business Services, Physicians, Advanced Practice Providers, Leaders, and others as appropriate or requested. &nbsp;</li></ol><ol start="6" style="margin-bottom: 3pt;"><li>Assist in the implementation, training, and monitoring of compliance policies and operating procedures related to billing compliance.</li></ol><ol start="7" style="margin-bottom: 3pt;"><li>Prepare reports for the Executive Compliance Committee and/or senior management at the SOM and SIU HC for review by compliance leadership. Report on key findings to the Executive Compliance Committee.</li></ol><ol start="8" style="margin-bottom: 3pt;"><li>Participate as a member of various committees or working groups focused on billing compliance and compliance risk assessment activities to support compliance leadership.&nbsp;</li><li>Assist in the development and presentation of education modules/programs for billing providers, medical residents, and staff members related to the Compliance Work Plan, or, audit results.&nbsp;</li></ol><ol start="10" style="margin-bottom: 3pt;"><li>Maintain reference materials related to billing compliance laws, regulations, and guidelines. Partner with Patient Business Services, Coding and other related teams to provide communication, guidance and education to Physicians, Advanced Practice Providers, et al.</li></ol><h2>Minimum Qualifications</h2><div style="margin-left: -15px; margin-right: -15px; color: rgba(0, 0, 0, 1); font-style: normal; text-indent: 0;"><div style="padding-left: 15px; padding-right: 15px; width: 1170px;">CREDENTIALS TO BE VERIFIED BY PLACEMENT OFFICER </div><ul type="disc" style="margin-bottom: 3pt;" data-pasted="true"><li>Bachelor’s degree in Health Information Management (HIM), Healthcare Administration, Medical Coding, Business Administration, Public Administration, Healthcare Management, or related field with coursework relating to healthcare operations includes the following topics: Medical Terminology, Human Anatomy and Physiology, ICD-10 Coding, and CPT Coding, or closely related courses.</li><li>A total of 1 year work experience in a healthcare setting (i.e., hospital, physician’s office, nursing home, billing agency) utilizing ICD-10, and CPT coding systems, Healthcare Common Procedure Coding System (HCPCS), and the Current Procedural Terminology (CPT) systems of coding to assign codes for services provided to patients.</li><li>Any one of the following certifications: Certified Professional Coder-Apprentice (CPC-A), Certified Professional Coder (CPC) or a Certified Outpatient Coder (COC) by the American Academy of Professional Coders (AAPC) (formerly CPC-H certification) or current certification as a Certified Coding Associate (CCA), Certified Coding Specialist (CCS) or Certified Coding Specialist-Physician-based (CCS-P) or Registered Health Information Technician (RHIT) or Registered Health Information Administrator (RHIA) by the American Health Information Management Association (AHIMA).</li></ul>Note: Master’s Degree in an area consistent with the duties of the position may be substituted for one (1) year of work experience. Knowledge, Skills and Abilities (KSAs)<ol style="margin-top: 0; margin-bottom: 3pt;"><li>Knowledge of principles and methods for curriculum and training design, teaching and instruction for individuals and groups, and the measurement of training effects</li><li>Knowledge of business and management principles involved in strategic planning, resource allocation, human resources modeling, leadership technique, production methods, and coordination of people and resources</li><li>Skill in analyzing information and evaluating results to choose the best solution and solve problems.</li><li>Skill in scheduling events, programs, and activities, as well as the work of others.</li><li>Skill in oral and written communication</li><li>Ability to adjust actions in relation to others' actions.</li><li>Ability to listen to and understand information and ideas presented through spoken words and sentences</li><li>Ability to apply general rules to specific problems to produce answers that make sense</li><li>Ability to develop goals and plans to prioritize, organize, and accomplish work.</li><li>Ability to work effectively with staff, the public, and outside constituency groups</li><li>Ability to effectively plan, delegate, and supervise the work of others.</li><li>Ability to utilize various computer software packages, such as Accounting Software, query, etc.</li><li>Ability to work independently and exercise judgment in order to be able to analyze and investigate a variety of questions or problems</li><li>Ability to analyze and develop guidelines, procedures and systems</li></ol></div><div style="margin-left: -15px; margin-right: -15px; color: rgba(0, 0, 0, 1); font-style: normal; text-indent: 0;"> </div>Condition of Employment&nbsp; Pursuant to the State Universities Civil Service System, an out-of-state resident who is hired into this position&nbsp;must establish Illinois residency within 180 calendar days of their start date.&nbsp;<h2>Other Qualifications</h2> <undefined><img src="https://secure.neoed.com/images/AgencyImages/jobposting/14507/jobpostings/image/20260319083631_Screenshot 2026-03-19 103618.png" style="width: 300px;" class="fr-fic fr-dii" data-uw-rm-alt-original="" data-uw-rm-alt="AI"></undefined>

Billing Compliance Specialist (5002)

Billing Compliance Specialist

Bachelor’s in HIM/Healthcare Admin or related; 1 year healthcare coding experience; professional coder certifications (CPC-A/CPC/COC/CCA/CCS/CCS-P/RHIT/RHIA) or RHIT/RHIA; Master’s degree substitution allowed.

Coder Jobs in Maroa, IL, US

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