Professional Coding Lead

Company Overview

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Shriners Children’s is an organization that respects, supports, and values each other. Named as the 2025 best mid-sized employer by Forbes, we are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience define us as leaders in pediatric specialty care for our children and their families.

 

All employees are eligible for medical coverage on their first day! In addition, upon hire all employees are eligible for a 403(b) and Roth 403 (b) Retirement Saving Plan with matching contributions of up to 6% after one year of service. Employees in a FT or PT status (40+ hours per pay period) will also be eligible for paid time off, life insurance, short term and long-term disability and the Flexible Spending Account (FSA) plans and a Health Savings Account (HSA) if a High Deductible Health Plan (HDHP) is elected. Additional benefits available to FT and PT employees include tuition reimbursement, home & auto, hospitalization, critical illness, pet insurance and much more! Coverage is available to employees and their qualified dependents in accordance with the plans. Benefits may vary based on state law.

 

 

Job Overview

The Professional Coding Lead performs at an advanced level medical professional coding position and serves as an expert utilizing International Statistical Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT 4) classification system coding to all diagnoses, treatments and procedures in all types of Hospital, Clinic and Ambulatory Surgical Center (ASC) locations at stated minimum performance levels. The Professional Coding Lead supervises daily operations specific to professional coding and coder productivity. Develop staff coverage strategies to maintain consistent productivity flow and assists to cover staff PTO/position vacancies. Reviews employee timesheets and validates with timecards in the payroll system biweekly. Monitors the Professional Hold Report weekly to ensure coding is completed timely and to request information from responsible departments as well as develop strategies to minimize un-coded accounts greater than the bill hold period. Supports Professional Coding Team by discussing complex coding cases, answering questions, providing education and interfacing with Leadership. Runs daily and weekly status reports and distributes to appropriate parties. Completes edits in Bill scrubber and CBO and identifies payer specific guidelines and process improvement opportunities. Communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. The Professional Coding Lead will also provide training for all new professional coders and monitors staff progress.

Responsibilities

• Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology and medical terminology to identify diagnoses and procedures
• Interpret ICD-10; CPT 4; Healthcare Common Procedure Coding (HCPC) and modifier codes for services rendered accurately and completely
• Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations
• Identifies trends in documentation deficiencies and presents along with creative solutions
• Acts as a key liaison for the clinical staff as it relates to coding and compliance
• Interacts with Physician and Executive Leadership and other professional staff of documentation issues relating to coding data
• Acts as a mentor to Professional Coding team
• Reviews employee timesheets and validates with timecards in the payroll system biweekly
• Manages Professional Coding Team schedule including PTO and coverage
• Provides onboarding system and workflow training to newly employed coders
• Performs 100% audit for all newly employed coders and provides feedback
• Monitors staff quality performance and provides education to support correct coding
• Prepares and presents education in conjunction with the Revenue Integrity Professional Coding Educator
• Primary contact for Revenue Cycle and Clinical teams throughout Shriners Hospitals for Children (SHC) system to assist with coding questions
• Prepares and distributes queue status reports to Coding Leadership on a daily and weekly basis
• Performs scheduled surgical audits for Provider feedback and communicates results to Surgeons
• Bill Scrubber coding WQ Edits and trends results
• Professional Coding WQ and trends denial reasons

 

 

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