Coder Lead - Inpatient / Facility

Department:

10407 Revenue Cycle - Facility Production Coding Inpatient

Status:

Full time

Benefits Eligible:

Yes

Hours Per Week:

40

Schedule Details/Additional Information:

First Shift

This is a REMOTE Opportunity

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. Managemen