Coding Lead

Position Title:

Department:

Job Description:

General Description:

The Coding Lead performs as a daily contact individual for coding, Diagnosis Related Group (DRG)/code validation, operational, and general questions from the “coding” staff, Health Information Management (HIM), and shared service center departments.  The Coding Lead provides support to coding leadership in coordinating coding and education activities within the department.  The Coding Lead works to achieve and maintain overall company-defined department goals.  The Coding Lead works to ensure compliance with national coding guidelines, coding policies, and Company coding policies for complete, accurate and consistent coding and/or DRG/code validation resulting in appropriate reimbursement, data integrity, and minimal variation in coding practices.

Essential Responsibilities:

Responsibilities listed in this section are core to the position.  Inability to perform these responsibilities with or without an accommodation may result in disqualification from the position. 

• Leads, coordinates and performs coding quality reviews (e.g., routine, policy driven, performance driven, incentive plan driven, customer needs, identified trends, RAC, payer, etc.) for inpatient and/or outpatient coding (e.g., DRG/code validation, query validation)
• Provides timely feedback and education as it relates to coding opportunities found during the review of accounts
• Ensures rebill requests are entered timely through the system/process outlined in company/policy
• Answers coding related questions and assists Coding Integrity Specialists (CIS), Coding Account Reimbursement Specialists (CARS), and/or Clinical Document Integrity (CDI) Liaisons with day‐to‐day operations
• Assists Coding Manager in the review and improvement of processes and services
• Ensures accounts are reviewed timely to ensure cash flow, sustain accuracy, and meet filing deadlines and claim submission deadlines utilizing various tools (e.g., eRequest, Bill 49 tool(s), HIM Coding Prebill Account Review Tool [C-PART)).
• Coordinates activities in conjunction with the Coding Manager and SSC Education staff related to the development, education, training, and orientation of the CISs, CDI Liaison, and/or CARS team members
• Reports to the Coding Manager periodically on team and individual work accomplishments, problems, progress in mastering tasks and work processes, and individual and team training needs
• Coach, facilitate, solve work problems, and participate in the work of the team
• Assists the Coding Manager in verifying and reporting staff productivity for Coding, DRG/Code Validation, Unbilled, CDI reconciliation and CARS functions
• Assists in ensuring staff adherence with coding guidelines and policy
• Assists in ensuring coding compliance and reports status to the Coding Managers and Coding Director
• Assures accounts that cannot be coded are held for valid reasons and documented accurately utilizing
• Unbilled Reason Codes (URCs)
• Monitors HPF work queues and allocates resources appropriately
• Prepares facility specific reporting requirements
• Occasionally provides back up for CISs, CDI Liaison, Coding Mentor, and/or CARS
• Promptly reports issues or trends to the Coding Manager(s) and/or Coding Director
• Participates in interdepartmental/multidisciplinary team meetings, committees and/or task force(s)
• Assist in ensuring compliance with Regulatory Coding Compliance educational requirements and policies
• Performs interim DRG assignments
• Initiates physician queries in compliance with Company policy where appropriate
• Meets all educational requirements as stated in current Company policy
• Reviews all official data quality standards, coding guidelines, Company policies and procedures, and clinical/medical resources to assure coding knowledge and skills remain current

General Responsibilities:

• Performs other duties as assigned

Minimum Qualifications:

Education: High School Diploma or GED required. Associate's degree or higher in HIM/HIT strongly preferred.

Experience:  5 years of experience in acute care inpatient/outpatient coding required.  4 or more years of healthcare experience in coding auditing preferred.  Lead or supervisory experience preferred.

Licensure/Certifications/Registrations Required: Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Professional Coder (CPC) required.

Knowledge, Skills and Abilities:

• Coding Technical Skills‐ extensive regulatory coding (ICD‐10‐CM, ICD‐10‐PCS, CPT/HCPCS,, MS‐DRGs, APR DRGs) and associated reimbursement knowledge.
• Case Mix Index Analytical Skills – ability to analyze trends in CMI and determine root cause and address as appropriate.
• Effective Decision Making – relating and comparing; securing relevant information and identifying key issues; committing to an action after developing alternative courses of action that take into consideration resources, constraints, and organizational values Initiative – independently takes prompt proactive steps toward problem resolution.
• Organization – establishing courses of action to ensure that work is completed efficiently; proactively prioritizes assignments and keen ability to multi‐task.
• Communication ‐ communicates clearly, proactively and concisely with all key stakeholders.
• Leadership ‐ leads individuals and groups toward desired outcomes, setting high performance standards and delivering leading quality services.
• Customer Orientation ‐ establishes and maintains long‐term customer relationships, building trust and respect by consistently meeting and exceeding expectations.
• Policies & Procedures ‐ articulates knowledge and understanding of organizational policies, procedures and systems.
• PC Skills ‐ demonstrates proficiency in Microsoft Office applications and others as required.
• Quality Orientation – accomplishing tasks by considering all areas involved, no matter how small; showing concern for all aspects of the job; accurately checking processes and tasks; being watchful over a period of time.
• Work Independently – is self‐supporting; not needing to rely on others to complete a job.
• Building and Maintaining Strategic Working Relationships – develops collaborative relationships to facilitate the accomplishment of work goals. Possesses good interpersonal skills in building, negotiating, and maintaining crucial relationships.
• Managing Conflict – dealing effectively with others in an antagonistic situation; using appropriate interpersonal styles and methods to reduce tension or conflict between two or more people.
• Mentor and Educate – provides timely guidance and feedback to help strengthen the knowledge/skill set of others to accomplish a task or solve a problem.

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OU Health is an equal opportunity employer. We offer a comprehensive benefits package, including PTO, 401(k), medical and dental plans, and many more. We know that a total benefits and compensation package, designed to meet your specific needs both inside and outside of the work environment, create peace of mind for you and your family.