Translate medical procedures and diagnoses into ICD‑10, CPT, and HCPCS codes in a hospital setting, ensuring compliance with coding guidelines and regulations.
Responsibilities
Perform inpatient coding of patient records
Add modifiers to maximize reimbursement
Collect and analyze visit information
Query providers for documentation
Utilize EHR and abstracting systems
Requirements
High School Graduate or equivalent
Certified Professional Coder (CPC)
Certified Coding Specialist – Physician (CCS‑P)
Registered Health Information Technician (RHIT)
Registered Health Information Administrator (RHIA)
Senior Inpatient Coding Specialist responsible for ICD-10 CM, ICD-10-PCS, DRG coding and abstraction for inpatient services.
Responsibilities
Identify appropriate assignment of ICD-10 CM, ICD-10-PCS, DRG, and abstraction for facility services while adhering to the official coding guidelines and established client coding guidelines of the assigned facility
Expert knowledge in Inpatient DRG Coding
Abstract additional data elements during the chart review process when coding, as needed
Adhere to the ethical standards of coding as established by AAPC and/or AHIMA
Adhere to and maintain required levels of performance in both coding quality and productivity as established by Optum
Develop and issue compliant physician queries based on clinical indicators, coding guidelines, and documentation gaps.
Review medical records to identify opportunities for clarification that impact DRG assignment, SOI/ROM, and reimbursement integrity.
Ensure all queries adhere to AHIMA and ACDIS standards for compliance and neutrality.
Track and follow up on outstanding queries to ensure timely response and resolution.
Collaborate with CDI professionals and inpatient coders to align documentation with coding and regulatory requirements.
Requirements
Bachelor’s degree or equivalent experience required
Clinical background or training as a Registered Nurse, Nurse Practitioner, Occupational Therapist, Physical Therapist, Physician Assistant, or Physician
Responsible for chart analysis and abstracting CPT, HCPCS, ICD codes and modifiers for surgical specialties, ensuring accurate coding, billing, and reimbursement.
Compensation
Pay Range Minimum: $33.47 hourly
Pay Range Maximum: $47.93 hourly
Responsibilities
Performs chart analysis and abstracts CPT, HCPCS, ICD codes and modifiers
Reviews and resolves coding issues and claim edits in Epic
Consults with physicians and clinical representatives to verify services
Makes coding corrections to resolve issues
Supports PFS by reviewing services for charge accuracy
Requirements
High school diploma or equivalent
Certified Health Information Technician (RHIT) or equivalent certifications
Responsible for accurate and timely medical billing for home infusion services, ensuring compliance with payer contracts and supporting revenue cycle operations.
Compensation
$25—$27 USD
Responsibilities
Prepare and submit insurance claims for home infusion services
Process electronic pharmacy claims for Medicare Part D, Medicaid, and commercial insurance plans
Ensure prescription reimbursement information is complete, accurate, and entered in a timely manner before weekly and month-end close
Review documentation to ensure it aligns with billed services, coding, and expected reimbursement
Review and accurately apply payments to patient accounts through final resolution
Requirements
High school diploma or GED
Nice to have: 5+ years of medical billing and collections experience
Nice to have: Previous home infusion or infusion therapy billing experience
Nice to have: Experience with CareTend, CPR+, or similar healthcare billing systems
Responsible for maintaining low denial rates and optimizing reimbursement across the enterprise by ensuring high coding standards and effective denial management practices.
Responsibilities
Manages clinical denials from assigned work queues, including claim resubmissions, authorization verification, payer reprocessing, reconsiderations, and appeals
Partners closely with Managed Care and payers to reduce denials and improve reimbursement outcomes
Analyzes denial trends and develops recommendations to improve coding accuracy and documentation practices
Meets established productivity and accuracy standards, including reviewing approximately 30 accounts per day with a 98% accuracy rate
Applies coding guidelines (NCCI, ICD-10, CPT, HCPCS, CMS) to accurately review, code, and correct accounts
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