Lead Medical Coder

JOB PURPOSE: The Lead Coder will be able to code all patient types as needed; inpatient, swing bed, same-day surgery, ancillary, ambulatory and provider-based clinics. This individual will mentor, train and assist with cross training coding staff, including newly hired coding staff. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and procedures for hospital and physician (professional) services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10-CM/PCS and CPT/HCPCS.

ESSENTIAL FUNCTIONS INCLUDE BUT NOT LIMITED TO:

• Ensures that coding compliance initiatives are met with all record types.
• Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed.
• Assist with productivity reporting and reducing DNFC.
• Codes complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD-10-CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment and all required modifiers.
• Validates charges by comparing charges with health record documentation as necessary, adding procedure and professional charges as appropriate.
• Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.
• Tracks issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.
• Consistently meets or exceeds coding quality and productivity standards established by coding department.
• Adheres to confidentiality requirements as they relate to release of any individual or aggregate patient information.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Performs other duties as assigned by leadership.
• Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.
• Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, ICD-10-CM/PCS diagnostic and procedural coding including CPT/HCPCS and DRG or APC grouping coding principles and guidelines.
• Experience utilizing coding references, encoder software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
• Ability to use standard desktop and windows-based computer system, including basic understanding of email, internet, and computer navigation.
• Maintain a high level of accuracy in code assignment to prevent claim denials, billing errors, and potential legal issues.
• Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist to clarify documentation, to resolve coding-related queries, and to ensure accurate and timely claim submission and reimbursement related to Inpatient, Outpatient, or Ambulatory coding.
• Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials.
• Uphold professional ethics, integrity, and confidentiality in handling patient information.
• Extensive knowledge of hospital and professional coding including provider-based billing.
• Other duties as assigned.

BEHAVIORAL STANDARDS

• The individual must support the mission, vision, and goals of Avem Health Partners and serve as a role model within the company.
• Exhibit positive customer service behavior in every day work interactions.
• Demonstrate a courteous and respectful attitude to internal workforce and external customers.
• Communicate accurately and appropriately.
• Handle difficult situations in a discreet and professional manner.
• Hold self-accountable for professional practice.
• Participate in performance improvement activities utilizing principles to support and improve departmental goals.
• Demonstrate knowledge of unit goals and is active in committees and projects to achieve these goals.
• Keep current with literature regarding changing practices, interventions and best practices.
• Assume responsibility for seeking out educational and professional opportunities for personal learning needs and growth as well as meeting mandatory education requirements.
• Act as a preceptor as requested.
• Demonstrate excellent work attendance and actively participate in a variety of meetings and training sessions as required.
• Adhere to the Avem Health Partners Code of Conduct and Standards of Behavior. Complies with established policies and procedures and all health and safety requirements.

EDUCATION/QUALIFICATIONS:

• High School diploma or equivalent and Medical Coding Education. Preferred bachelors degree in Health Information Management, Business Administration or related field.
• Three (3) years of verifiable, progressive coding experience. Preferred more than five (5) years of coding experience in an acute care hospital setting.

CERTIFICATION/LICENSURE:

• Certified Coding Specialist (CCS) Required or equivalent.

PHYSICAL REQUIREMENTS:

• To perform this job successfully, an individual must be able to perform each essential job duties satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. Such accommodations must be requested by the employee/applicant to be considered.
• This job requires visual abilities, auditory abilities, must be intact to perform duties.

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