Coder Lead - Inpatient / Facility

Major Responsibilities:

• Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues.
• Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards.
• Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy. May assist with provider education/orientation regarding policy requirements of federal and state government agencies.
• Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols. Detects, reports and acts as a resource to assist in resolving billing compliance issues. Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders.
• Responsible for processing denial management claims and addressing patient concerns. Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit. Coordinates payer audit reviews and acts as a resource for coding-related audits.
• Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. Acts as the system/application administrator; ensures the integrity of the system and recognizes performance issues. Performs calibration and troubleshooting procedures and escalates unresolved issues as needed.
• Suggests modifications to current policies and procedures that are needed to coincide with requirements of insurance payers. Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver.
• Adhere to organizational and internal department policies and procedures to ensure efficient work processes. Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.
• Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement. Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.
• Meets and exceeds departmental quality (95% or more) and productivity standards (100%). Achieves productivity expectations to support discharged not final billed (DNFB). Assist in the production of annual edit review based on CPT, ICD and HCPCS changes as well as assist in development of edits based on publications and society updates.
• Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time. Answer and prioritize correspondence at all levels e.g., coding assistants, coders, leads, supervisors, and managers.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), or

• Certified Coding Specialist (CCS) certification issued by the American Health information Management Association (AHIMA), or

• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or

• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA)

Education Required:

• Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)

Experience Required:

• Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience.  

Knowledge, Skills & Abilities Required:

• Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.
• Advanced profiency of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
• Excellent communication (oral and written) and interpersonal skills.
• Excellent organization, prioritization, and reading comprehension skills.
• Excellent analytical skills, with a high attention to detail. 
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.