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

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Coder Jobs

Carle Health

Riverside Healthcare

Onsite

Remote

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.

Overview The Accounts Receivable (AR) Team Lead at Riverside Healthcare plays a pivotal role in overseeing all billing and collection activities related to insurance accounts receivable. This position, under indirect supervision, is responsible for the coordination, training, and mentoring of the AR team members, ensuring accurate and timely processing of insurance claims and follow-ups. The AR Team Lead acts as a key resource for all departments within the health system, offering expertise in contracted insurance payers, coding, and fostering a collaborative team environment. This role also emphasizes adherence to patient satisfaction principles and requires the ability to perform additional tasks as assigned and demonstrates flexibility with assignments within professional scope/duties/licensure.Essential Duties<ul><li>Team Leadership & Training: Lead, train, and mentor the AR team, ensuring all members are equipped with the necessary skills and knowledge to perform their duties effectively.</li><li>Billing & Collections: Oversee all billing and collection activities related to insurance accounts receivable, ensuring accuracy and compliance with established procedures.</li><li>Claims Management: Handle complex insurance denials, perform root cause analysis, and implement corrective actions to reduce and prevent future denials. Engage in appeals processes to secure payment resolution.</li><li>Process Improvement: Identify and recommend opportunities for improving customer service, system processes, and overall efficiency. Partner with management to implement necessary changes.</li><li>Compliance & Standards: Ensure adherence to HIPAA privacy standards and compliance with patient health information privacy practices in all communications. Maintain an understanding of evolving payer classifications and reimbursement policies.</li><li>Coding & Documentation: Review and resolve coding-related denials, correcting CPT, ICD-10, and HCPCS codes as needed. Maintain coding compliance and stay updated with recognized coding guidelines and billing requirements.</li><li>Collaboration: Actively participate in payer calls, provide feedback to payer representatives, and escalate issues as necessary. Keep the manager informed of progress, achievements, and any issues that arise.</li><li>Productivity & Quality: Run staff productivity, perform monthly audits, and provide feedback to staff. </li><li>Special Projects: Assist with special projects and other duties as assigned, as necessary.</li><li>Continuing Education: Participate in trainings and seminars as assigned by the Patient Accounting Manager to stay current with industry standards and improve job performance.</li></ul>Non-essential Duties<ul><li>Assist with other administrative duties or tasks as assigned by management.</li><li>Support cross-functional teams as needed for comprehensive billing and collection processes.</li></ul> Responsibilities Required Experience<ul><li>Completion of ICD-10 and CPT coding courses from AAPC or AHIMA is required</li><li>2-3 years of experience in collections, claims follow-up, or denials required.</li></ul>Preferred Experience<ul><li>Experience in a physicians office or other healthcare setting preferred.</li><li>Knowledge of insurance and authorization processes is helpful.</li><li>Previous experience with EPIC is preferred.</li><li>Understanding of the hospital or physician revenue cycle is preferred.</li></ul>Required Licensure/Education<ul><li>High School Diploma or equivalent required.  </li><li>Certified Coder required or must obtain within 6 months of hire.</li></ul>Preferred Education<ul><li>Strong analytical and problem-solving skills.</li><li>Excellent communication and interpersonal skills.</li><li>Ability to work independently and as part of a team.</li><li>Proficiency in maintaining confidentiality and adhering to privacy regulations.</li></ul>This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.Our Commitment to You:Riverside Healthcare offers a comprehensive suite of Total Rewards: benefits and nationally rated employee well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more so your journey at and away from work is remarkable. Our Total Rewards package includes: Compensation<ul><li>             Base compensation within the positions pay range based on factors such as qualifications, skills, relevant experience, and/or training</li><li>             Premium pay such as shift differential, on-call</li><li>             Opportunity for annual increases based on performance</li></ul>Benefits - .5 to 1.0 FTE<ul><li>             Paid Time Off programs</li><li>             Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability</li><li>             Health Savings and Flexible Spending Accounts for eligible health care and dependent care expenses</li><li>             Defined contribution retirement plans with employer match and other financial wellness programs</li><li>             Educational Assistance Program</li></ul>Benefits - .001 to .49 FTE: <ul><li>             Paid Leave Hours accrued as you work</li></ul>Employee Health RequirementsExposure/Sensory Requirements: Exposure to:<ul><li>Chemicals: None </li><li>Video Display Terminals: Extreme </li><li>Blood and Body Fluids: None </li><li>TB or Airborne Pathogens: None. </li></ul>Sensory requirements (speech, vision, smell, hearing, touch): <ul><li>Speech: Needed for presentations/training, telephone communication, facilitate meetings. </li><li>Vision: Needed to read memos and literature. </li><li>Smell: N/A </li><li>Hearing: Needed for telephone communications, meetings, and listening to employee concerns. </li><li>Touch: Need to write, do computer entry, filing. </li></ul>Activity/Lifting Requirements Percentage of time during the normal workday the employee is required to: <ul><li>Sit: 85% </li><li>Twist: 0% </li><li>Stand: 5% </li><li>Crawl: 0% </li><li>Walk: 5% </li><li>Kneel: 0% </li><li>Lift: 2% </li><li>Drive: 0% </li><li>Squat: 1% </li><li>Climb: 0% </li><li>Bend: 1% </li><li>Reach above shoulders: 1% </li></ul>The weight required to be lifted each normal workday according to the continuum described below: <ul><li>Up to 10 lbs: Occasionally </li><li>Up to 20 lbs: Occasionally </li><li>Up to 35 lbs: Not Required </li><li>Up to 50 lbs: Not Required </li><li>Up to 75 lbs: Not Required </li><li>Up to 100 lbs: Not Required </li><li>Over 100 lbs: Not Required </li></ul>Describe and explain the lifting and carrying requirements. (Example: the distance material is carried; how high material is lifted, etc.): Lifting is not usually required. Maximum consecutive time (minutes) during the normal workday for each activity: <ul><li>Sit: 408 </li><li>Twist: 0 </li><li>Stand: 24 </li><li>Crawl: 0 </li><li>Walk: 24 </li><li>Kneel:0 </li><li>Lift: 9 </li><li>Drive: 0 </li><li>Squat: 8 </li><li>Climb: 0 </li><li>Bend: 8 </li><li>Reach above shoulders: 4 </li></ul>Repetitive use of hands (Frequency indicated): <ul><li>Simple grasp up to 10 lbs. Normal weight: 5- 10# frequent </li><li>Pushing & pulling Normal weight: </li><li>Fine Manipulation: Terminal entry, calculator. </li></ul>Repetitive use of foot or feet in operating machine control: None Environmental Factors &Special Hazards <ul><li>Environmental Factors (Time Spent): </li><li>Inside hours: 40 </li><li>Outside hours : 0 </li><li>Temperature: Normal Range</li><li>Lighting: Average </li><li>Noise levels: Average </li><li>Humidity: Normal Range </li><li>Atmosphere: Dust &Poor Ventilation </li></ul>Special Hazards: None Protective Clothing Required: None  Pay Range USD $24.12 - USD $29.50 /Hr

AR TEAM LEAD

AR Team Lead

Lead AR team; 2-3 years collections/denials; ICD-10/CPT coding courses; HS diploma; Certified Coder or must obtain within 6 months.

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