Located in the metropolitan area of Sacramento, the Adventist Health corporate headquarters have been based in Roseville, California, for more than 40 years. In 2019, we unveiled our WELL-certified campus - a rejuvenating place for associates systemwide to collaborate, innovate and connect.
Whether virtual or on campus, Adventist Health Roseville and shared service teams have access to enjoy a welcoming space designed to promote well-being and inspire your best work.
Job Summary: Serves as a subject matter expert in hospital and professional coding and interacts with other teams and departments across the organization such as patient financial services, revenue integrity (charge description master) team, provider teams and/or compliance on a routine basis. Performs coding for cardiac/IVR procedures and maintains required quality and productivity standards while remaining compliant with third party, state and federal regulations.
Reviews and resolves medical necessity edits that may apply for any outpatient surgical encounters, applying hospital and professional modifiers to CPT codes, and processes any errors associated with the revenue cycle process. Assists in the design and implementation of workflow changes to reduce coding and billing errors.
Reviews medical record documentation and accurately assigns appropriate ICD-10-CM diagnoses, CPT codes and modifiers as applicable for both the hospital and professional claim. Validates and processes any medical necessity edits (local or national coverage determinations) that may apply for hospital and professional coding.
Monitors discharged not billed accounts, and as a team, ensures timely, compliant processing of outpatient and inpatient encounters through the hospital and professional revenue cycle. Codes and posts charges for inpatient and outpatient complex cardiac and interventional radiology procedures and diagnoses for the purpose of reimbursement, research, statistical data gathering, and compliance.
Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes. Maintains current knowledge of coding guidelines and reimbursement reporting requirements.
Demonstrates a high degree of independence in performance of responsibilities, working effectively without direct supervision. Exhibits strong time management, problem solving and communication skills.
Job Requirements:
Education and Work Experience: High School Education/GED or equivalent: Required Two years experience if certified interventional radiology cardiovascular coder (CIRCC); otherwise, ten years experience: Required Experience in an acute care setting: Preferred Experience in cardiac and IVR coding: Required
Licenses/Certifications: Certified Coding Specialist (CCS): Required Certified Interventional Radiology Cardiovascular Coder (CIRCC) or earn certification within one year of hire: Required CIRCC-AAPC: Required
Essential Functions: Performs specialty acute cardiac/IVR coding functions. Handles return for coding review and resolution. Performs charge reviews and makes corrections as needed. Communicates complex concepts in simple form to non-finance users to understand the appropriate use and limits of information provided. Performs other job-related duties as assigned.
Organizational Requirements:
Adventist Health is committed to the safety and wellbeing of our associates and patients. Therefore, we require that all associates receive all required vaccinations as a condition of employment and annually thereafter, where applicable. Medical and religious exemptions may apply.
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Adventist Health is a faith-based, nonprofit, integrated health system serving more than 100 communities on the West Coast and Hawaii with over 440 sites of care, including 27 acute care facilities. Founded on Adventist heritage and values, Adventist Health provides care in hospitals, clinics, home care, and hospice agencies in both rural and urban communities.
Our compassionate and talented team of more than 38,000 includes employees, physicians, Medical Staff, and volunteers driven in pursuit of one mission: living Gods love by inspiring health, wholeness and hope.