jobboard3

In accordance with federal coding compliance regulations and guidelines, use current ICD-10-CM, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in outpatient medical records (i.e. OP Ancillary/Clinic Visits, and an assorted outpatient surgeries: GI Lab, Heart Cath Lab, Pain Management surgery, and Invasive Radiology, etc.). Address OCE/NCCI edits within 3M-CRS and those returned from the Business Office. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Performs other coding department related duties as assigned by HIM management staff.Essential Duties:Ambulatory Surgery coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.Reviews the entire medical record; accurately classify and sequence diagnoses and procedures; ensure the capture of all documented conditions that coexist at the time of the encounter/visit, all medical necessity diagnoses, complications, co-morbidities, historical condition or family history that has an impact on current care or influences treatment, and all external causes of morbidity.Enter patient information into inpatient and outpatient medical record databases (ClinTrac/HDM). Ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements prior to billing interface and claims submission.Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.Assists in the correction of regulatory reports, such as OSHPD data, as requested.Attendance, punctuality, and professionalism in all HIM Coding and work related activities.Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions. Completes tasks accurately, legibly, and in a timely fashion.Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.Ability to achieve a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).Ability to achieve a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).Assist in ensuring that all medical records contain information necessary for optimal and accurate coding and abstracting.Recognizes education needs of based on monthly reviews and conducts self-improvement activities.Ability to act as a resource to coding and hospital staff on coding issues and questions.Ability to improve MS-DRG assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.Ability to improve APR-DRG, SOI, and ROM assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.Ability to improve APC/HCC assignments specific to medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.Maintains at minimum, expected productivity standards (See HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.Works coding queues/task lists to ensure 95% of patient bills are dropped within 5 days after patient discharge/date of service.Works coding queues/task lists to ensures the remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.Assist other coders in performance of duties including answering questions and providing guidance, as necessary.Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and/or providing information so that an interim bill can be generated. Assists with physicians, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed.Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority.Maintains AHIMA and or AAPC coding credential(s) specified in the job description.Attend coding & CDI seminars, webinars, and in-services to maintain the required annual continued education units (CEU).Keep up-to-date and reviews ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, and CPT Assistant to maintain knowledge of the principles of coding.Keep up-to-date and reviews other professional journals and newsletters in a timely fashion to maintain knowledge of the principles of coding.Consistently attend and actively participate in the daily huddles.Consistently adhere to HIM policies and procedures as directed by HIM management.Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed.Participates in continuously assessing and improving departmental performance.Ability to communicate changes to improve processes to the director, as needed.Assists in department and section quality improvement activities and processes (i.e. Performance Improvement).Works and communicates in a positive manner with management and supervisory staff, medical staff, co-workers and other healthcare personnel.Ability to communicate effectively intra-departmentally and inter-departmentally.Ability to communicate effectively with external customers.Provides timely follow-up with both written and verbal requests for information, including voice mail and email.Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage.Working knowledge, efficient navigation, & full use of 3M-CRS Encoder system; utilize to expedite coding process; utilize all references.Knowledge & understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac.Working knowledge, efficient navigation, & full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software.Working knowledge, efficient navigation, & full use of ‘3M 360 Encompass/CAC’.Performs other duties as assigned.Required Qualifications:Req High school or equivalentReq Specialized/technical training Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding courseReq 1 year Experience in ICD-9 & ICD-10 (combined) and CPT/HCPCS coding of ambulatory surgery medical records in hospital or outpatient surgical center.Req Experience in using computereized coding & Abstracting database software and encoding/code-finder systems.Req Knowledge of federal coding compliance regulations and guidelines.Req Knowledge of medical terminology.Req Strong computer skills.Preferred Qualifications:Required Licenses/Certifications: Req Certified Coding Specialist – CCS (AHIMA) or AHIMA Certified Coding Specialist – Physician (CCS-P); or AAPC Certified Professional Coder (CPC); or AAPC Certified Outpatient Coding (COC) If there is the absence of a national coding certificate and the coder possesses any one of the following national certifications, the coder will be required to pass any of the national coding examinations Re: the aforementioned coding certificates within six (6) months of employment: 1. AHIMA Registered Health Information Technician (RHIT) 2. AHIMA Registered Health Information Administrator (RHIA) Successful completion of the hospital specific coding test – with a passing score of ≥70%. The coding test may be waived for former USC or agency/contract HIM Coding Dept. coders who historically/previously met the ≥ 90% internal/external audit standards of the previously held USC Job Code.Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The hourly rate range for this position is $39.00 – $63.95. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

In accordance with current federal coding compliance regulations and guidelines, use current ICD-10-CM/PCS, CPT-4, and HCPCS code sets/systems to accurately abstract, code, and electronically record electronically record into the 3M Coding & Reimburse System (3M-CRS) & the coding abstracting system (3M-ClinTrac), all diagnoses, surgical procedures, and other significant invasive and non-invasive procedures documented by any physician in any inpatient medical records (i.e. Medicare, non-Medicare, and all complex cases). Meet the productivity and accuracy/quality standards. Initiates appropriate clinical documentation querying CDI Specialists in order to acquire or clarify necessary medical record documentation needed to facilitate accurate and complete coding & abstracting. Understands PFS coding/billing processes & systems such as PBAR and nThrive/MedAssets/XClaim in a manner to assure claims drop timely with appropriate codes. Perform other coding department related duties as assigned by HIM management staff.Essential Duties:Inpatient coding of all diagnostic and procedural information from the medical records using ICD-10-CM, ICD-10-PCS, and CPT/HCPCS, and Modifier classification systems and abstracting patient information as established and required by official coding laws, regulations, rules, guidelines, and conventions.Reviews the entire medical record; accurately classify and sequence diagnoses and procedures; ensure the capture of all documented conditions that coexist at the time of the encounter/visit, all medical necessity diagnoses, complications, co-morbidities, historical condition or family history that has an impact on current care or influences treatment, and all external causes of morbidity.Enter patient information into inpatient and outpatient medical record databases (ClinTrac/HDM). Ensures accuracy and integrity of medical record abstracted UB-04 & OSHPD data elements prior to billing interface and claims submission.Works cooperatively with HIM Coding Support and/or Clinical Documentation Improvement Specialist in obtaining documentation to complete medical records and ensure optimal and accurate assignment of diagnosis & procedure codes.Assists in the correction of regulatory reports, such as OSHPD data, as requested.Attendance, punctuality, and professionalism in all HIM Coding and work related activities.Consistently assumes responsibility and displays reliability for completion of tasks, duties, communications and actions. Completes tasks accurately, legibly, and in a timely fashion.Performs other duties as requested/assigned by Director, Manager, Supervisor, or designee.Ability to achieve a minimum of 95% coding accuracy rate as determined by any internal or external review of coding and/or department quality review(s).Ability to achieve a minimum of 95% abstracting accuracy rate of UB-04 and OSHPD data elements as determined by any internal or external review of coding and/or department quality review(s).Assist in ensuring that all medical records contain information necessary for optimal and accurate coding and abstracting.Recognizes education needs of based on monthly reviews and conducts self-improvement activities.Ability to act as a resource to coding and hospital staff on coding issues and questions.Ability to improve MS-DRG assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.Ability to improve APR-DRG, SOI, and ROM assignments specific to the documentation & coding of PDx, SecDx, CC/MCC, PPx, and SecPx in accordance with official coding laws, regulations, rules, guidelines, and conventions.Ability to improve APC/HCC assignments specific to medical necessity documentation & coding of PDx, SecDx, and CPT/HCPCS in accordance with official coding laws, regulations, rules, guidelines, and conventions.Maintains at minimum, expected productivity standards (See HIM Practice Guidelines) and strives to maintain a steady level of productivity and provides consistent effort.Works coding queues/task lists to ensure 95% of patient bills are dropped within 5 days after patient discharge/date of service.Works coding queues/task lists to ensures the remaining 5% of patient bills are dropped within 2 weeks of discharge/date of service.Assist other coders in performance of duties including answering questions and providing guidance, as necessary.Assists Patient Financial Services (PFS), Patient Access, and other departments in addressing coding issues/questions and/or providing information so that an interim bill can be generated. Assists with physicians, physician office staff and hospital ancillary department staff with diagnostic or procedural coding issues/questions, as needed.Assists in the monitoring unbilled accounts to ensure that the oldest records are coded and/or given priority.Maintains AHIMA and or AAPC coding credential(s) specified in the job description.Attend coding & CDI seminars, webinars, and in-services to maintain the required annual continued education units (CEU).Keep up-to-date and reviews ICD-10 Official Guidelines for Coding & Reporting, AHA Coding Clinic, and CPT Assistant to maintain knowledge of the principles of coding.Keep up-to-date and reviews other professional journals and newsletters in a timely fashion to maintain knowledge of the principles of coding.Consistently attend and actively participate in the daily huddles.Consistently adhere to HIM policies and procedures as directed by HIM management.Demonstrates an understanding of policies and procedures and priorities, seeking clarification as needed.Participates in continuously assessing and improving departmental performance.Ability to communicate changes to improve processes to the director, as needed.Assists in department and section quality improvement activities and processes (i.e. Performance Improvement).Works and communicates in a positive manner with management and supervisory staff, medical staff, co-workers and other healthcare personnel.Ability to communicate effectively intra-departmentally and inter-departmentally.Ability to communicate effectively with external customers.Provides timely follow-up with both written and verbal requests for information, including voice mail and email.Working knowledge and efficient navigation of the Electronic Health Record (EHR): Cerner/Powerchart & Coding mPage.Working knowledge, efficient navigation, & full use of 3M-CRS Encoder system; utilize to expedite coding process; utilize all references.Knowledge & understanding of PFS system (PBAR) functionality and any interface with the coding abstracting system: ClinTrac.Working knowledge, efficient navigation, & full use of ‘HDM/HRM/ARMS Core’ coding & abstracting software.Working knowledge, efficient navigation, & full use of ‘3M 360 Encompass/CAC’.Performs other duties as assigned.Required Qualifications:Req High school or equivalentReq Specialized/technical training Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding course. Successful completion of the hospital specific coding test – with a passing score of ≥85%. The coding test may be waived for former USC or agency/contract HIM Coding Dept. coders who historically/previously met the ≥ 90% internal/external audit standards of the previously held USC Job Code.Req 3 years Experience in ICD-9 & ICD-10 (combined) coding of inpatient medical records in an acute care facility and experience in using a computerized coding & abstracting software and an encoding/code-finder database systemsReq Working knowledge of CPT, HCPCs and ICD9 coding principlesReq Organization/time management skills.Req Demonstrate excellent customer service behavior.Req Demonstrates excellent verbal and written communication skills.Req Able to function independently and as a member of a team.Preferred Qualifications:Required Licenses/Certifications: Req Certified Coding Specialist – CCS (AHIMA) OR AAPC Certified Inpatient Coder (CIC) OR either the CCS or CIC with any one of the following national HIM certifications: 1. AHIMA Registered Health Information Technician (RHIT) 2. AHIMA Registered Health Information Administrator (RHIA)Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only) The hourly rate range for this position is $46.00 – $76.07. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

Receive and manage all incoming inquiries from any customer; patient, insurance company, USC employee as walk-ins or via telephone or written correspondence. Documents all activity in the facility’s patient accounting system. Requirements will include being well versed in insurance products, medical group risks, and all governmental programs and benefits structures. Must be knowledgeable of the Financial Assistance Programs and all screening requirements. Contacts and work collaboratively with the financially responsible party with regards to patient liability. Partner to evaluate the ability to meet their obligation and collect monies due to the organization. Able to work with minimal supervision.Receive and manage all incoming inquiries from any customer; patient, insurance company, USC employee as walk-ins or via telephone or written correspondence. Documents all activity in the facility’s patient accounting system. Requirements will include being well versed in insurance products, medical group risks, and all governmental programs and benefits structures. Must be knowledgeable of the Financial Assistance Programs and all screening requirements. Contacts and work collaboratively with the financially responsible party with regards to patient liability. Partner to evaluate the ability to meet their obligation and collect monies due to the organization. Able to work with minimal supervision.Essential Duties:Must deliver compassion and respect at all encounters while assisting patients and callers with billing questions and insurance coverage determination on the phone, via email or in person.Responsible for calling/confirming insurance coverage through use Internet portals to obtain and system documentation: a) Insurance eligibility and benefits, b) Financial responsibilityComplete registration fields, document all calls, actions in follow-up system. Confirm/update guarantor, insurance and demographics. Demonstrate ingenuity, self-reliance and resourcefulness. Able to take needed action without direct instructions.Demonstrates ability to deescalate matters – in person or over the phone – providing customers with options to problem solve. Ensure to follow-up timely and embody the USC spirit in all transactions.Responsible for calculating patient liability and cash quotes on hospital and professional accounts and communicating/collecting the liability from the patient.Must deliver consistent and timely communication with clinic offices regarding inquires of cash quote, patient liability and additional insurance related questions.Provide quality service and support to patients and/or client groups. Demonstrate a positive image and perform responsibilities in a professional manner. Ensure that all insurance benefit(s), plan registration, CPT code(s), ICD 10 and all related services provided are accurate; meet the customer’s needs, in a timely manner.Perform all other duties assignedRequired Qualifications:Req High school or equivalentReq 2 years Experience in a high volume organization with strong customer service background.Req Knowledge of collection techniques.Req Effective written and verbal communication skills.Req Excellent customer service skills and telephone etiquette.Req Problem solving skills essential.Req Insurance knowledge and communication with payers.Req Ability to think independently and use good judgment for situations which require initiative and innovation.Req Knowledge of basic office equipment.Req Ability to establish work priorities and prioritize needs to meet required timelines.Req Analytical and problem-solving skills.Req 10 Key by touch and ability to type 45 wpm.Req Basic math calculation skills.Preferred Qualifications:Pref 2 years Experience in hospital or health care setting.Pref Computer literacy, including proficiency in MS Word, Excel and some knowledge of Access (preferred).Pref Understanding of hospital reimbursement methodologies, including DRGs, APGs and standard payment methodology:Pref Knowledge of ICD-9, CPT-4 and HCPC’s coding systemsPref Working knowledge of Medicare, Medicaid and all other third party payment methods:Pref Understanding of contract payer policies and proceduresPref Ability to interpret Managed Care ContractsPref Bilingual English/SpanishRequired Licenses/Certifications: Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The hourly rate range for this position is $22.00 – $34.18. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Coding Supervisor supervises inpatient and ambulatory professional coding workflows. Monitors and assesses performance of coding staff to assure timely, accurate coding. Assures delivery of coding staff education and training. Informs, educates and coordinates with other revenue cycle and clinical operations staff regarding coding and charge capture for professional services. This is a working coding position in addition to supervising.Essential Duties:Supervises and performs a wide range of activities pertaining to the review and coding of professional services including inpatient, ambulatory and complex procedures.Manages coding staff resources based on department need.Orients and trains new coding staff as well as performs ongoing training for existing coding staff.Partners with CBO staff on un-billed accounts to ensure timely charge capture.Works with the Director to develop and recommend policies and procedures.Mentors and assists in training of other coders within the department.Performs data quality reviews to ensure adherence to CPT and/or CMS guidelines.Analyzes TES coding-related edits and internal coding inquiries to identify opportunities for improvement.Performs other duties as assigned.Required Qualifications:Req High school or equivalentReq Specialized/technical training Successful completion of an accredited Coding Program. *Successful completion of college courses in Medical Terminology or Anatomy & Physiology preferred.Req 5 years Professional coding experience in ICD-CM and CPT-4.Req 2 years Experience in a Supervisory role.Req Must be able to function as an immediate liaison to providers and departments related to clinical documentation improvement and optimal charge capture.Req Effectively partner with revenue cycle staff on coding denials management.Req Effectively analyze coding and documentation trends and develop education and training based on this information.Req Will be required to pass coding test.Req Knowledge of medical terminology and coding.Req Demonstrates ability to work independently with minimal direction and supervision.Req Demonstrates ability to utilize effective, appropriate and diplomatic oral and written communication skills.Preferred Qualifications:Required Licenses/Certifications: Req Certified Coding Specialist – CCS (AHIMA) OR Certified Professional Coder – CPC (AAPC)Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The annual base salary range for this position is $81,120.00 – $133,010.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Coding Supervisor supervises inpatient and ambulatory professional coding workflows. Monitors and assesses performance of coding staff to assure timely, accurate coding. Assures delivery of coding staff education and training. Informs, educates and coordinates with other revenue cycle and clinical operations staff regarding coding and charge capture for professional services. This is a working coding position in addition to supervising.Essential Duties:Supervises and performs a wide range of activities pertaining to the review and coding of professional services including inpatient, ambulatory and complex procedures.Manages coding staff resources based on department need.Orients and trains new coding staff as well as performs ongoing training for existing coding staff.Partners with CBO staff on un-billed accounts to ensure timely charge capture.Works with the Director to develop and recommend policies and procedures.Mentors and assists in training of other coders within the department.Performs data quality reviews to ensure adherence to CPT and/or CMS guidelines.Analyzes TES coding-related edits and internal coding inquiries to identify opportunities for improvement.Performs other duties as assigned.Required Qualifications:Req High school or equivalentReq Specialized/technical training Successful completion of an accredited Coding Program. *Successful completion of college courses in Medical Terminology or Anatomy & Physiology preferred.Req 5 years Professional coding experience in ICD-CM and CPT-4.Req 2 years Experience in a Supervisory role.Req Must be able to function as an immediate liaison to providers and departments related to clinical documentation improvement and optimal charge capture.Req Effectively partner with revenue cycle staff on coding denials management.Req Effectively analyze coding and documentation trends and develop education and training based on this information.Req Will be required to pass coding test.Req Knowledge of medical terminology and coding.Req Demonstrates ability to work independently with minimal direction and supervision.Req Demonstrates ability to utilize effective, appropriate and diplomatic oral and written communication skills.Preferred Qualifications:Required Licenses/Certifications: Req Certified Coding Specialist – CCS (AHIMA) OR Certified Professional Coder – CPC (AAPC)Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The annual base salary range for this position is $81,120.00 – $133,010.00. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems. Ensure all insurance plans are properly selected in all registration and scheduling information systems. Responsible for calling insurance or use Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and / or Pre-Certification as required. (20%)Responsible for understanding and articulating patient’s liability by performing mathematical calculations in understanding out of pocket, co-insurance and deductible calculations. Responsible for full calculations on all Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures by following the appropriate documentation standard guidelines. (20%)Responsible for contacting Physician office when a patient’s services are denied, re-directed and or when a Peer to Peer is required. Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals and same day surgeries. (20%)Responsible for submitting authorizations for Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures. Submits authorizations via the Valor software tool and or websites and follows the appropriate protocol when submitting authorizations. Responsible for clearing assigned worklists in any of the information systems (15%)Responsible for completing Documentation of all authorization information is entered in all appropriate registration fields and follows the approved documentation standard guidelines. Submit pre-certification documentation to third party payers for authorization with correct CPT and ICD coding. Research payer medical policy requirements for treatment authorizations and understand process for submitting pre-certification requests. Follow up for routine requests from the message center are followed up on 3-5 business days consistently. Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system. (15%)Perform all other duties as assigned. (10%)Required Qualifications:Req High school or equivalent Or GED required.Req 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.Req Broad experience in financial counseling and co-pay collections.Req Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.Req The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.Req Ability to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.Req Strong problem solving customer skills.Req Knowledge of business office procedures.Req Knowledge of medical terminology and coding.Req Knowledge of grammar, spelling, and punctuation to type patient information.Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.Preferred Qualifications: Required Licenses/Certifications: Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The hourly rate range for this position is $22.00 – $34.18. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Financial Clearance Specialist III is responsible for ensuring insurance eligibility, benefit verification, and the authorization processes are complete in the time allowed by the insurance companies to prevent denials or penalties. Documenting accurate insurance information and authorization details to optimize reimbursement from both the payer and patient. Maintain strong working knowledge of insurance plans, contract requirements, and resources to facilitate appropriate insurance verification and authorization. Must be able to run eligibility and secure full benefit coverage information (including COBRA when applicable) with insurance companies and employers, confirm all demographic information is correct, and ensure coordination of benefit (COB) and insurance plan codes are accurate. Verify insurance coverage immediately for inpatient and outpatient accounts that are same day and next day add-ons. Determine if pre-certification, pre-authorization or a referral is required for insurance companies and obtain if applicable. Communicate with providers and team regarding out-of-network issues, assess contracted and non-contracted payer issues, and document outcomes and next steps. Determine, communicate, and collect patient liability prior to service and attempt to collect prior balances. Conduct all transactions appropriately and consistently, and complete Medicare Secondary Questionnaire accurately with the patient or patient’s representative. Maintain compliance with HIPAA regulations as it pertains to the insurance processes. Maintain professional development by attending workshops, in-services, and webinars to remain up-to-date on insurance rules and regulations in addition to changes within the industry. Responsible in submitting authorizations for surgery, GI , Imaging chemotherapy, Infusions, invasive and non-invasive procedures, transplants, and all other services as required.Essential Duties:Responsible for obtaining insurance information/verification/authorization to ensure financial clearance of patient accounts. Updates both professional and / or hospital registration systems. Ensure all insurance plans are properly selected in all registration and scheduling information systems. Responsible for calling insurance or use Internet portals to obtain and document: a) Insurance eligibility and benefits, b) Financial responsibility, c) Authorization and / or Pre-Certification as required. (20%)Responsible for understanding and articulating patient’s liability by performing mathematical calculations in understanding out of pocket, co-insurance and deductible calculations. Responsible for full calculations on all Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures by following the appropriate documentation standard guidelines. (20%)Responsible for contacting Physician office when a patient’s services are denied, re-directed and or when a Peer to Peer is required. Communicate with physician offices regarding proposed admissions, special procedures, outpatient referrals and same day surgeries. (20%)Responsible for submitting authorizations for Surgery, GI, Chemo/Infusions, Imaging on non and invasive procedures. Submits authorizations via the Valor software tool and or websites and follows the appropriate protocol when submitting authorizations. Responsible for clearing assigned worklists in any of the information systems (15%)Responsible for completing Documentation of all authorization information is entered in all appropriate registration fields and follows the approved documentation standard guidelines. Submit pre-certification documentation to third party payers for authorization with correct CPT and ICD coding. Research payer medical policy requirements for treatment authorizations and understand process for submitting pre-certification requests. Follow up for routine requests from the message center are followed up on 3-5 business days consistently. Scan all authorizations into appropriate system under the respective patient accounts and document authorization outcomes in the registration system. (15%)Perform all other duties as assigned. (10%)Required Qualifications:Req High school or equivalent Or GED required.Req 2 years Admitting/ insurance verification experience in a hospital, health plan or Physician office environment.Req Broad experience in financial counseling and co-pay collections.Req Ability to submit authorization and articulate full insurance benefits for Surgery, GI, Imaging, Chemo Therapy, Infusions, and invasive and non- invasive procedures is highly desirable.Req The extended ability to perform mathematical calculations, extensive experience in hospital and medical business office setting.Req Ability to interrupt patient’s insurance coverage, identify services that are not covered benefit and provide clear explanation to patients and providers.Req Strong problem solving customer skills.Req Knowledge of business office procedures.Req Knowledge of medical terminology and coding.Req Knowledge of grammar, spelling, and punctuation to type patient information.Req Must be able to verify insurance and advanced knowledge of both CPT codes and medical terminology.Req Must also be able to understand and interpret patient liability and benefits for HMOs and all payer types.Req Ability to read, understand, and follow oral, and written instructions and establish and maintain effective working relationships with patients, employees, and the public.Req Excellent time management, organizational skills, research/analytical skills, negotiation, communication (written and verbal), and interpersonal skills.Req Capable of reading the policy and procedure manual and understanding information pertaining to specific job duties and the general information for all hospital employees.Preferred Qualifications:Required Licenses/Certifications: Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The hourly rate range for this position is $22.00 – $34.18. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Senior HIM Coding Denials Management Specialist is a seasoned inpatient coding professional or coding auditor responsible for triaging, identifying payer’s reason for claim denials/rejections, analyzing, and resolving inpatient and outpatient coding-related insurance claim denials, rejections, and DRG downgrades in compliance with all applicable federal and state regulations. This role operates at the intersection of medical coding, billing, clinical documentation, and payer compliance, ensuring accurate claim submission, effective rebuttals & appeals, and optimal reimbursement. Under general supervision, the specialist reviews and triages payer-denial type, prepares and submits first- and second-level coding-related appeals, and conducts in-depth regulatory, coding, and clinical research to support rebuttals. The role collaborates closely with coding, billing, CDI, and clinical teams to resolve root causes of denials, implement corrective actions, creates denials reports/dashboards, and drive continuous revenue cycle improvement through data analysis and process monitoring.Essential Duties:Denials Triage & Resolution • Review and triage PFS-related, coding-related, and clinical-related denials and DRG downgrades. • Independently manage and resolve coding-related inpatient and outpatient claim denials, rejections, and DRG downgrades. • Analyze payer denial rationale related to ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRGs, APR-DRGs, APCs, and modifiers. • Interpret payer-specific payment methodologies and contractual payable/non-payable benefit structures.Appeals Management • Prepare, submit, and track first- and second-level coding-related appeals to Medicare, Medi-Cal, MACs, RACs, QIOs, and commercial payers. • Develop comprehensive rebuttal letters and appeal packages supported by clinical documentation, coding guidelines, and regulatory references. • Document all appeal activity, correspondence, and outcomes within coding and billing systems. • Coordinate follow-up with Patient Financial Services (PFS) regarding reimbursement outcomes.Regulatory, Coding & Clinical Research • Perform in-depth research using IPPS/OPPS Federal Register, NCDs, LCDs, NCCI edits, Official Coding Guidelines, AHA Coding Clinic, CPT Assistant, and related authoritative sources. • Ensure all work is compliant with federal and state coding laws, regulations, and payer policies. • Apply regulatory and coding guidance to defend coding decisions during audits and payer disputes.Root Cause Analysis & Process Improvement • Identify and trend recurring denial patterns and DRG downgrades. • Conduct root cause analysis to determine systemic coding, documentation, or workflow issues. • Develop and recommend corrective action plans in collaboration with coding, billing, CDI, and clinical teams. • Support documentation improvement initiatives by initiating queries through CDI when clarification is required.Reporting & Performance Monitoring • Develop and maintain reports to monitor denial volumes, trends, appeal outcomes, and success rates. • Utilize data to support performance improvement, education, and revenue cycle optimization initiatives. • Provide actionable insights to leadership to reduce future denials and improve coding accuracy.Communication & Collaboration • Serve as a liaison between coders, clinicians, CDI specialists, billing teams, PFS, and external payers. • Communicate professionally and effectively with internal stakeholders and external entities. • Provide timely written and verbal follow-up, including emails, documentation notes, and verbal discussions. • Maintain strong working relationships with physicians and leadership through clear, ethical, and solution-focused communication.Information Systems & Technology • Utilize and navigate EHR and coding systems efficiently, including: ◦ Cerner/PowerChart and Coding mPage ◦ Solventum/3M 360 Encompass (CAC/CRS) ◦ Solventum/3M HDM, HRM, and ARMS Core ◦ Soarian Financials and related PFS interfaces • Leverage system tools and embedded references to support accurate coding, denial resolution, and appeals processing.Perform other duties as assigned.Required Qualifications:Req High School or equivalentReq Specialized/technical training Successful completion of college courses in Medical Terminology, Anatomy & Physiology and a certified coding course. Must possess a thorough knowledge of ICD/DRG coding and/or CPT/HCPCS coding principles, and the recommended American Health Information Management Association (AHIMA) coding competencies.Req 10 years Experience in ICD, CPT/HCPCS coding of inpatient & outpatient medical records in an acute care facility.Req Experience in using a computerized coding & abstracting database software and encoding/code-finder systems [e.g., 3M 360 Encompass/CAC & 3M Coding & Reimbursement System (CRS)].Req Working knowledge of CPT, HCPCs and ICD9 coding principlesReq Organization/time management skills.Req Demonstrate excellent customer service behavior.Req Demonstrates excellent verbal and written communication skills.Req Able to function independently and as a member of a teamPreferred Qualifications:Pref 1 – 2 years Lead Experience.Required Licenses/Certifications: Req AHIMA Certified Coding Specialist (CCS) only; or AAPC Certified Inpatient Coder (CIC) only; or either the CCS or CIC in conjunction with any one of the following national HIM credentials: 1. AHIMA Registered Health Information Technician (RHIT) 2. AHIMA Registered Health Information Administrator (RHIA) Successful completion of the hospital specific coding test – with a passing score of ≥90%. The coding test may be waived for former USC or agency/contract HIM Coding Dept. coders who historically/previously met the ≥ 90% internal/external audit standards of the previously held USC Job Code.Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)The hourly rate range for this position is $46.00 – $76.07. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Licensed Vocational Nurse II (LVN II) is an individual with specific knowledge and technical skills to assist the Registered Nurse (RN) or Medical Provider. The LVN II utilizes the Nursing Process to provide therapeutic care to a specific population of patients, under the direction of the RN or Provider. LVN II will provide excellent quality care including patient education, phlebotomy and may participate in coordinating specific services as directed.Essential Duties:Uses and practices basic assessment, participates in planning, executes interventions in accordance with the plan of care or treatment plan, and contributes to evaluation of individualized interventions related to the care plan or treatment planEscorts patients to exam rooms, obtains and appropriately records patient vital signs/medication list, monitors patient flow, assists physicians with minor clinical procedures, performs EKGs, prepares patient chart with pertinent medical information, administers medication as directed by physician.Provides direct patient care.Administers medications.Assess and monitor patients condition and notify physician/health care professional.Demonstrates professional communication skills for the purpose of patient care, education and multidisciplinary team collaboration.Schedules diagnostic tests ordered by the physician as needed.Schedules and receives patients.Prepares and maintains medical records.Performs various administrative duties, including answering phone patient calls, returning phone calls, receiving and sorting in-coming faxes, obtaining prior authorizations.Enters charges into the system in an accurate and timely fashion.Handles telephone calls and writes correspondences.Serves as a liaison between physicians and other individuals.Takes patient histories and vital signs.Implements an effective and efficient patient flow.Performs first aid and CPR if needed.Assists physicians with exams and treatments as permitted by license. Assist medical personnel with special procedures, minor surgical procedures and/or diagnostic examsOrganizes pharmacy refill requests for physician approval.Ability to work independently and in a team setting to accomplish duties in a timely manner.Provide medical information and education to patients, following established protocols and guidelines.Triages patients in person and over the telephone.Ensures patient’s right to privacy, safety, and confidentiality is maintained. Maintains a safe environment in accordance with standards, policies, and safety regulations. Ensures compliance with infection control policies.Assess and monitor patients condition and notify physician/health care professional.Assist medical personnel with special procedures, minor surgical procedures and/or diagnostic exams.Provide medical information and education to patients, following established protocols and guidelines.Administers a broader range of medications, including injections and IV medications.Performs other duties as assigned..Required Qualifications:Req High School or equivalentReq Specialized/technical training Graduate of an accredited Vocational Nursing ProgramReq 3 years Experience in an acute care or ambulatory care setting.Req Demonstrates ability to effectively work with physicians, staff, and patients.Req Proficient computer skills in Microsoft Word as well as Internet access and utilization.Req Demonstrate excellent customer service behavior.Req Strong interpersonal skills to handle sensitive situations and confidential informationReq Able to make decisions effectively and with appropriate stakeholder inputPreferred Qualifications:Required Licenses/Certifications: Req Licensed Vocational Nurse – LVN (CA DCA) Valid California Vocational Nursing licenseReq Basic Life Support (BLS) Healthcare Provider from American Heart AssociationReq Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)Req LVN – Intravenous Therapy Certification (CA DCA) IV certificationReq Keck Program Preceptor Certification *If new hire, must obtain certification within 90 days/next classThe hourly rate range for this position is $29.00 – $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.

The Licensed Vocational Nurse II (LVN II) is an individual with specific knowledge and technical skills to assist the Registered Nurse (RN) or Medical Provider. The LVN II utilizes the Nursing Process to provide therapeutic care to a specific population of patients, under the direction of the RN or Provider. LVN II will provide excellent quality care including patient education, phlebotomy and may participate in coordinating specific services as directed.Essential Duties:Uses and practices basic assessment, participates in planning, executes interventions in accordance with the plan of care or treatment plan, and contributes to evaluation of individualized interventions related to the care plan or treatment planEscorts patients to exam rooms, obtains and appropriately records patient vital signs/medication list, monitors patient flow, assists physicians with minor clinical procedures, performs EKGs, prepares patient chart with pertinent medical information, administers medication as directed by physician.Provides direct patient care.Administers medications.Assess and monitor patients condition and notify physician/health care professional.Demonstrates professional communication skills for the purpose of patient care, education and multidisciplinary team collaboration.Schedules diagnostic tests ordered by the physician as needed.Schedules and receives patients.Prepares and maintains medical records.Performs various administrative duties, including answering phone patient calls, returning phone calls, receiving and sorting in-coming faxes, obtaining prior authorizations.Enters charges into the system in an accurate and timely fashion.Handles telephone calls and writes correspondences.Serves as a liaison between physicians and other individuals.Takes patient histories and vital signs.Implements an effective and efficient patient flow.Performs first aid and CPR if needed.Assists physicians with exams and treatments as permitted by license. Assist medical personnel with special procedures, minor surgical procedures and/or diagnostic examsOrganizes pharmacy refill requests for physician approval.Ability to work independently and in a team setting to accomplish duties in a timely manner.Provide medical information and education to patients, following established protocols and guidelines.Triages patients in person and over the telephone.Ensures patient’s right to privacy, safety, and confidentiality is maintained. Maintains a safe environment in accordance with standards, policies, and safety regulations. Ensures compliance with infection control policies.Assess and monitor patients condition and notify physician/health care professional.Assist medical personnel with special procedures, minor surgical procedures and/or diagnostic exams.Provide medical information and education to patients, following established protocols and guidelines.Administers a broader range of medications, including injections and IV medications.Performs other duties as assigned..Required Qualifications:Req High School or equivalentReq Specialized/technical training Graduate of an accredited Vocational Nursing ProgramReq 3 years Experience in an acute care or ambulatory care setting.Req Demonstrates ability to effectively work with physicians, staff, and patients.Req Proficient computer skills in Microsoft Word as well as Internet access and utilization.Req Demonstrate excellent customer service behavior.Req Strong interpersonal skills to handle sensitive situations and confidential informationReq Able to make decisions effectively and with appropriate stakeholder inputPreferred Qualifications:Required Licenses/Certifications: Req Licensed Vocational Nurse – LVN (CA DCA) Valid California Vocational Nursing licenseReq Basic Life Support (BLS) Healthcare Provider from American Heart AssociationReq Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)Req LVN – Intravenous Therapy Certification (CA DCA) IV certificationReq Keck Program Preceptor Certification *If new hire, must obtain certification within 90 days/next classThe hourly rate range for this position is $29.00 – $45.20. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.