Responsibilities
- Reviews clinical documentation to assign correct ICD-10-CM, CPT, and modifier codes for both facility and professional billing.
- Verifies and resolves medical necessity edits based on local or national coverage policies for inpatient and outpatient services.
- Processes payer-specific coding edits relevant to hospital and professional claims to support claim accuracy.
- Collaborates with clinical providers across departments to promote better documentation practices.
- Adheres to state and federal coding standards and regulatory guidelines in all coding activities.
- Monitors discharged patient accounts not yet billed and helps ensure timely, compliant revenue cycle processing.
- Maintains required levels of coding quality and productivity as defined by departmental benchmarks.
- Performs assigned duties independently with minimal supervision and high reliability.
- Demonstrates effective time management, problem-solving, and interpersonal communication abilities.
- Applies critical thinking and sound judgment in resolving complex coding and documentation issues.
- Communicates clearly and professionally in both written and verbal formats.
- Stays current with CMS policies, NCCI edits, NCDs, LCDs, and payer-specific rules to ensure clean claims.
- Complies with all organizational policies and operational procedures.
- Attends mandatory training sessions, meetings, and completes annual education requirements for professional development.
- Follows Joint Commission standards, including cultural sensitivity, patient rights, safety protocols, emergency preparedness, and ethical conduct.
- Upholds C-I-CARE principles in all interactions, emphasizing patient-centered care, respect, and teamwork.
Work Arrangement
Remote
Other
- Blood Borne Pathogens Category II - Tasks that involve NO exposure to blood, body fluids or tissues, but employment may require performing unplanned Category I tasks
- These principles apply to ALL employees: SHC Commitment to Providing an Exceptional Patient & Family Experience
- Stanford Health Care sets a high standard for delivering value and an exceptional experience for our patients and families. Candidates for employment and existing employees must adopt and execute C-I-CARE standards for all of patients, families and towards each other. C-I-CARE is the foundation of Stanford’s patient-experience and represents a framework for patient-centered interactions. Simply put, we do what it takes to enable and empower patients and families to focus on health, healing and recovery. You will do this by executing against our three experience pillars, from the patient and family’s perspective: Know Me: Anticipate my needs and status to deliver effective care Show Me the Way: Guide and prompt my actions to arrive at better outcomes and better health Coordinate for Me: Own the complexity of my care through coordination
- Equal Opportunity Employer
- Stanford Health Care (SHC) strongly values diversity and is committed to equal opportunity and non-discrimination in all of its policies and practices, including the area of employment. Accordingly, SHC does not discriminate against any person on the basis of race, color, sex, sexual orientation or gender identity and/or expression, religion, age, national or ethnic origin, political beliefs, marital status, medical condition, genetic information, veteran status, or disability, or the perception of any of the above. People of all genders, members of all racial and ethnic groups, people with disabilities, and veterans are encouraged to apply. Qualified applicants with criminal convictions will be considered after an individualized assessment of the conviction and the job requirements.
- Day - 08 Hour (United States of America)
