The Home health & Hospice Coder possesses the knowledge and ability to code inpatient, outpatient, ED, Home Health & Hospice records, and professional fee services using ICD-9/10 CM and CPT-4. Ensures adherence to Hospital and Departmental Policies and Procedures.
The Senior Professional Coder performs at an advanced level medical coding position and serves as an expert utilizing ICD-10 and CPT4 classification system coding to all diagnoses, treatments and procedures in all types of Hospital, Clinic and Ambulatory Surgical Center (ASC) locations. They provide coding insight and guidance to clinical staff, Clinical Documentation Improvement (CDI), Professional Coder 1 and Professional Coder II positions as well as Revenue Cycle leadership.
The Clinical Documentation Improvement Partner collaborates with physician offices to translate healthcare documentation into standardized codes, ensuring accurate coding and billing of patient encounters, as supported by the medical record, and serves as a subject matter expert in Coding and Documentation.
Responsible for reviewing OASIS and/or coding for home health and hospice agencies, you’ll play a critical role in ensuring the integrity of clinical documentation and reimbursement. You’ll review OASIS assessments, validate ICD-10 coding, and provide actionable insights that support quality care and operational excellence. If you're detail-oriented, certified, and thrive in a remote, fast-paced environment, we’d love to have you on our team.
Assist the Medical Review team by providing education and identifying training opportunities during mentoring process and participate in on-site audits and ALJ hearings as needed. Analyze, evaluate, and conduct medical review investigations, studies, and data review in accordance with the UPIC policies and contract responsibilities. Conduct in depth claim review of providers suspected of fraud.
The Coordinator is primarily responsible for providing data and reports in support of the Coding and Compliance Department. They will compile billing and revenue data from internal systems upon request for the Coding Compliance team to review and analyze. The role involves preparing data summaries for Leadership and other departments, including the Executive leadership team.
The Supervisor, HCC Risk Adjustment Coding is responsible for performing HCC risk adjustment coding and developing and executing risk adjustment coding education, auditing, compliance initiatives, and clinical documentation improvement strategies. The Supervisor will supervise HCC risk adjustment coders and will collaborate with providers, coding teams, and leadership to drive performance improvement, mitigate compliance risks, and enhance HCC coding accuracy.
Coder III demonstrates proficiency in coding high acuity inpatient accounts and/or coding of technical outpatient accounts to support Revenue Cycle goals for timely billing. Utilizes International Classification of Disease (ICD-10-CM and PCS), Healthcare Common Procedure Coding System (HCPCS) including Current Procedural Terminology (CPT) and other coding references to ensure accurate coding. Examines the complete medical record to accurately determine the diagnoses, procedures, and complications.
Acts as a liaison between patients, providers, and insurance companies to ensure appropriate data collection, compliance with third party payers and federal and state regulations. Obtains benefits, eligibility and preauthorization, and acts as a financial counselor when explaining insurance and payment options.