Highmark Health

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: We are seeking an Outpatient Medical Coding Specialist to join our team, where you will play a crucial role in reviewing medical records to extract essential medical and demographic information. Your expertise in ICD and CPT coding systems will ensure accurate interpretation of diagnoses and procedures, directly enhancing our accounts receivable efficiency. ESSENTIAL RESPONSIBILITIES Conduct comprehensive reviews of medical information, including physician treatment plans and outcomes, to correctly assign ICD-10 CM/CPT codes for diagnoses and procedures. (65%) Extract and input data for statistical requests from hospitals, health systems, and medical professionals. (15%) Manage medical information effectively to promote cash flow concerning unbilled coding reports. (10%) Stay informed on updates to ICD-10 CM/CPT guidelines through ongoing training and resources, applying...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join a vital role within our team, focusing on the accurate management and coding of medical records. As an Inpatient Medical Records Coder, you will conduct thorough reviews to extract crucial medical and demographic information, applying diagnoses and procedures using ICD coding systems. Your expertise will play a key role in enhancing our financial efficiency by reducing average accounts receivable days. ESSENTIAL RESPONSIBILITIES: Conduct comprehensive reviews and interpretations of medical records, treatment plans, and outcomes to effectively assign the correct ICD codes for diagnoses and procedures. (65%) Abstract key data elements to meet statistical requirements from the hospital and health system, ensuring high accuracy in the coding and abstracted information input into the designated system. (15%) Efficiently manage medical information to support cash flow, including...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company: Allegheny Health Network Job Description: GENERAL OVERVIEW: Join our innovative team as a Medical Coding Auditor Instructor, where you'll play a vital role in ensuring the accuracy and compliance of coding, billing, and medical documentation. Conduct thorough audits on medical records regarding DRGs, APCs, CPTs, and HCPCS Level II codes. Your expertise will be key in optimizing reimbursement strategies and enhancing data quality while adhering to all regulatory standards. ESSENTIAL RESPONSIBILITIES: Lead comprehensive audits and evaluate documentation, coding, and billing practices across various AHN entities. Develop and implement focused training programs to address any deficiencies identified during audits, ensuring compliance with regulatory standards. Collaborate closely with management on external audit findings and engage in strategic discussions to resolve issues. (20%) Create detailed audit reports to highlight the impacts of coding,...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: This job performs thorough medical record review to abstract medical and demographic data, interpret and apply diagnoses and procedures utilizing ICD coding systems and assists in decreasing the average accounts receivable days. ESSENTIAL RESPONSIBILITIES Reviews and interprets medical information, physician treatment plans, course, and outcome to determine appropriate ICD codes for diagnoses and procedures. (65%) Abstracts data elements to satisfy statistical requests by the hospital, health system, medical staff, etc. and enters all coded/abstracted information into designated system. (15%) Ensures efficient management of medical information and cash flow as it pertains to the unbilled coding report. (10%) Keeps informed of the changes/updates in ICD guidelines by attending appropriate training, reviewing coding clinics and other resources and implementing these...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...

Company : Allegheny Health Network Job Description : GENERAL OVERVIEW: Performs all related internal, concurrent, prospective and retrospective coding audit activities. Reviews medical records to determine data quality and accuracy of coding, billing and documentation related to DRGs, APCs, CPTs and HCPCS Level II code and modifier assignments, ICD diagnosis and procedure coding, DRG/APC structure according to regulatory requirements. Reports findings both verbally and in writing and communicates results to affected areas. Uses information to generate topics for education, training, process changes, risk reduction, optimization of reimbursement with new and current coders in accordance with coding principles and guidelines. Promotes cooperation with CDMP and compliance programs to improve documentation which supports compliant coding. Interacts with external consultants regarding billing, coding and/or documentation and evaluates their recommendations and/or teaching...