PB CODING -Business Analyst III -

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Job Summary

JOB SUMMARY:

Responsible for coding and abstracting procedural (CPT) and diagnosis codes (ICD-10) for physician services, reviewing physician documentation in the electronic medical record. This position is responsible for monitoring, identifying, and reporting trends, risks, and discrepancies in charge capture and reports to the Coding Manager to ensure clear accountability for reconciliation; daily charge capture and revenue monitoring, to include consultation on eliminating lost charges/revenue. In addition, they will identify, analyze, and trend common denial reasons (e.g., medical necessity, diagnosis, coding errors, incorrect modifiers). Develop and implement strategies to overturn denials and accelerate payment resolution. Act as a subject matter expert for Epic Resolute PB, specifically as it relates to denial prevention and resolution. Analyze Epic workflows and configurations to identify root causes of lost revenue and/or denials stemming from provider and/or system setup or user error. Assist in troubleshooting Epic PB-related issues that lead to lost revenue and/or denials. Develop and maintain denial management policies and procedures. Prepare and present regular service line reconciliation reports on lost revenue and/or denials trends and team performance to RCM & Operational leadership and clients.

KEY RESPONSIBILITIES:

1. Responsible for reviewing, analyzing, and interpreting physician documentation, CPT and diagnosis coding, charge entry, coding claim edit, for monitoring, identifying, and reporting trends, risks, and discrepancies in charge capture and coding denial management for coding related tasks. Monitors medical records to ensure documentation complies with professional and payer policies and regulations.

2. Monitors unbilled accounts

3. Query and educate physicians on proper documentation techniques and improvement opportunities. Maintains working knowledge of payer specific coding guidelines, medical terminology, modifier usage, and NCCI edit conventions, as well as healthcare billing and reimbursement guidelines. Audits orders and claims before submission for entirety and

accuracy and to minimize claim denials. Assesses records and prepares reports.

4. Develops effective working relationships with physicians and other stakeholders.

5. Must be able to act independently with only general supervision

6. Requires the ability to adapt quickly to new systems, tools, procedures, and protocols

7. This position requires interpersonal and communication skills, analytic and organizational skills, critical thinking, and the ability to meet deadlines

8. Tracking their own continuing education credits to maintain professional credentials

9. Performs other duties as assigned.

KNOWLEDGE, SKILLS, ABILITIES

Knowledge of ICD-10-CM and CPT coding principles and guidelines.

Current knowledge of revenue cycle processes and professional medical billing.

Current knowledge of code data sets to include Current Procedure Terminology (CPT), Healthcare Common Coding System (HCPCS), and International Classification of Diseases Tenth Revision (ICD-10) Codes.

Utilizes Microsoft Excel / Word, to document and report audit results. Expert level MS excel (Vlookup and SQL required). Disclaimer The above information is intended to describe the general nature and level of work being performed by people assigned to this job. It is not intended to be an exhaustive list of responsibilities, duties and skillsrequired of personnel so classified.

MINIMUM EDUCATION REQUIRED:

Bachelor's degree in business, Health Administration, Mathematics, Statistics, Computer Science, Engineering or related field

MINIMUM EXPERIENCE REQUIRED:

Three (3) or more years' experience in Revenue Cycle Analysis, Finance, Consulting, or Healthcare related Accounts Receivable role or Professional Coding experience. Working knowledge of medical terminology, anatomy, and physiology. Knowledge of EPIC EeMR.

MINIMUM LICENSURE/CERTIFICATION REQUIRED BY LAW:

None

ADDITIONAL QUALIFICATIONS: CPC, CCS, CPC-H, CCS-P, CCS-H, RHIA, RHIT, or equivalent coding certification required.

Core Competencies
These competencies reflect the values and behaviors expected of all Grady team members, regardless of role. They ensure that every employee contributes to safe, high-quality care, positive patient experience, and a collaborative work environment.

1. Patient-Centered Care - Demonstrates a commitment to delivering safe, compassionate, and high-quality care that prioritizes the well-being and satisfaction of patients and their families.
2.Integrity & Accountability - Acts ethically, maintains confidentiality, and accepts responsibility for actions, decisions, and outcomes.
3.Collaboration & Teamwork - Builds positive relationships, works effectively across departments, and supports colleagues to achieve shared goals.
4. Communication - Communicates clearly, respectfully, and effectively with patients, families, colleagues, and leadership.
5.Respect & Inclusion - Creates an inclusive environment by valuing diversity, treating others with dignity, and ensuring equitable care and opportunities for all.
6. Quality & Safety - Adheres to best practices, regulatory standards, and policies to ensure safe, reliable, and high-quality outcomes.
7. Adaptability & Resilience - Responds effectively to change, remains flexible in dynamic situations, and demonstrates resilience under pressure.
8. Continuous Improvement - Seeks opportunities to improve processes, skills, and outcomes through innovation, learning, and feedback.
9. Leadership & Professionalism - Inspires, guides, and develops individuals and teams while modeling professionalism, fairness, and transparency.
10. Employee Experience Focus - Champions a supportive and engaging employee journey that enables staff to thrive and, in turn, deliver exceptional patient care.

Grady Total Rewards
At Grady, we believe in supporting the health, well-being, and growth of every team member. Our Total Rewards package is designed to provide competitive pay and comprehensive benefits that make a difference in your life and career, including:

• Health & Wellness: Medical, dental, vision, and prescription drug coverage.

• Financial Security: Retirement savings plans with employer contributions, life insurance, and disability coverage.

• Work-Life Balance: Paid time off, holidays, and family leave benefits.

• Career Growth: Tuition reimbursement, professional development programs, and opportunities for advancement.

• Employee Support: Employee Assistance Program (EAP), wellness initiatives, and discounts on services.

Grady's Total Rewards are designed to ensure our employees feel valued, supported, and empowered, both at work and beyond.

Why Join Grady?
Grady Health System is more than a hospital - we are a vital part of Atlanta and the surrounding communities. For over 125 years, Grady has been committed to providing exceptional care, advancing health equity, and making a difference in the lives of those we serve. When you join Grady, you become part of a team that values excellence, compassion, innovation, and collaboration.

Here, every role matters. Whether you provide direct patient care, support our operations, or lead teams, you play an important part in fulfilling our mission. We offer opportunities to learn, grow, and build a meaningful career in an environment where your contributions are recognized and valued.

At Grady, we don't just work, we make an impact.

Equal Opportunity Employer Statement:
Grady Health System is proud to be an equal opportunity employer. We are committed to fostering a workforce where all employees feel valued, respected, and empowered to succeed. We prohibit discrimination and harassment of any kind based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other legally protected characteristic.

Grady is dedicated to creating an accessible work environment and provides reasonable accommodations to qualified individuals with disabilities to ensure equitable opportunities for success.