The role involves assessing, planning, implementing, and coordinating care management activities based on member needs to achieve quality, cost-effective healthcare outcomes. This includes developing personalized care plans, educating members and families, and coordinating necessary providers and community resources.

The coordinator is responsible for assisting in organ screening support by screening donor offers from the OPTN contractor according to transplant center criteria and OPTN policy within their assigned area. This includes providing initial responses, notifying transplant coordinators, and serving as the primary contact for OPO communication during the screening process.

The specialist will assess health record documentation to ensure assigned codes for diagnoses and procedures are supported, applying knowledge of clinical processes and terminology to assign accurate codes. This role involves reviewing and performing charge data entry into patient accounting systems while consulting with various hospital personnel and assisting stakeholders with customer service.

The Medical Coder is responsible for reviewing and assigning diagnostic and procedure codes to patient records for reimbursement and data purposes, ensuring accuracy and correct sequencing according to regulations. This involves maintaining a 95% coding accuracy threshold, reviewing charts, identifying discrepancies, and querying physicians for necessary clarification.