Senior Professional Coder

Department/Unit:

Health Information Management

Work Shift:

Day (United States of America)

Salary Range:

$60,367.47 - $90,551.20

The Senior Professional Coder will apply an advanced professional coding skill set to act as a service line coding team lead expert, working collaboratively to support all workflows related to professional fee coding/charging/denials follow-up. Coordinates with others as needed to ensure comprehensive and timely completion of professional coding processes. Audit CPT and ICD-10 diagnosis coding applied by providers and coding staff to assure compliance with federal and state regulations and insurance carrier guidelines. Provide education, instruction and training to providers and coding staff. Act as an expert for the HCC/Risk adjustment coding. This position is remote but does require onsite education to providers as needed.

Essential Duties and Responsibilities

• Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges applied by providers to assure compliance with federal and state regulations and insurance carrier guidelines. Ensuring established productivity and quality standards are met. Complex coding skill set required to act as service line expert.
• Assist Supervisor in the daily operations of coding team(s) in a Team Lead position, ensuring staff are meeting established coding/charge processing productivity and quality standards.
• Assume supervisory tasks for the assigned coding staff in absence of Supervisor.
• Perform accurate and compliant coding of CPT and ICD-10 diagnosis codes.
• Define and submit coding/edit rules for consideration to streamline coding accuracy and efficiency within multiple interfaced systems.
• Participate as a workflow expert in all levels of application testing to include test script building, script processing through varying test systems, charge import into applicable systems and detailed review of accuracy for each process.
• Assist with the implementation, testing, troubleshooting and maintenance of third-party vendor applications software.
• Assist in preparing, overseeing, and approving staff schedule to meet the needs of the department.
• Orient and train, provide feedback, and evaluate the staff as needed.
• Assist in establishing department goals and assure goals are achieved utilizing LEAN management skills.
• Participate in the recruitment and interview process to fill personnel vacancies.
• Perform System Manager tasks for specified applications in his/her absence to include: compile and create daily reports, Import charges into applicable systems. Research/correct coding validation errors during charge import.
• Assist in creating and updating policies and procedures to include system development and maintenance documentation.
• Perform timely medical record chart reviews (which could include prospective, concurrent & retrospective auditing) to ensure documentation and selection of HCC diagnosis codes meet the requirements set forth by CMS and the Official ICD-10-CM Guideline for Coding and Reporting. Code chronic disease that meets HCC and Risk Adjustment criteria. Validate missed coding opportunities.
• Conducts professional fee billing integrity reviews/audits for AMHS, including reviewing medical record documentation and coding to assess compliance with related rules and regulatory requirements, and to identify clinical documentation improvement opportunities.
• Identify trends based on audit/review findings and formulate recommendations for follow-up education and corrective actions. Effectively communicate and educate relevant parties with the results of review/audit activity; and help with development of related action plans.
• Assist with Denials Management to determine root causes and provide feedback and training to providers/staff to reduce denials.
• Acts as a liaison for external audits and organizes the process. Implements necessary changes/education based on findings.
• Attend and contribute in all PCO staff meetings, department meetings and all other meetings assigned.
• Fulfills department requirements in terms of providing work coverage and administration notification during periods of personnel illness, vacation, or education.
• Assume responsibility for professional development by participating in webinars, workshops and conferences when appropriate.
• Ability to work well with people from different disciplines with varying degrees of business and technical expertise.
• All other duties as assigned.

Qualifications

• High School Diploma/G.E.D. - required
• Two years or more prior experience in professional fee coding - required
• Knowledge of multiple coding specialties. - preferred
• Working knowledge