Lead Coder

Role Overview

• Coordinates, organizes and prioritizes the work flow activities for the coding area.
• Leads and/or coordinates shift operations, work assignments and daily priorities of assigned activities, resources, and/or associates.
• Serves as a leader through modeling, mentoring and training assigned staff.
• Manages assigned charge review and coding-related claim work queues to ensure timely and accurate charge capture.
• Accurately deciphers charge error reasons and plan follow-up steps.
• Reviews medical record documentation in the electronic health record and/or on paper.
• Identifies, enters and posts CPT-4 and ICD-10 codes to the electronic health record.
• Identifies need for medical records from outside the organization and follows established procedures to obtain.
• Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Contacts providers and/or support staff when clarification is needed to appropriately bill for services.
• Provides ongoing feedback based on observations from coding physician/provider documentation.
• Assists in educational needs of coding staff based on these conversations and questions.
• Corrects claim edit errors in the work queues, assures charges provide optimal appropriate reimbursement with appropriate documentation.
• Provides feedback and guidance to coders and clinicians on recurring errors.
• Suggests rules to proactively work these edits prior to claim edit.
• Partners with follow-up department to analyze payer updates affecting/resulting in coding denials and applies knowledge to assist in correction, submission, and payment of claims.
• Tracks denials and reports trends to leadership.
• Is watchful for charge review, claim edit, and coding-related denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement.
• Assists coding teammates with coding questions, charge review, claim edits, payer requirements, and clarification of policies, procedures, and processes where needed.
• Performs other duties as assigned.

Requirements

• High School diploma/GED or 10 years of work experience
• Three years' experience
• Certified Coding Associate (CCA)
• American Health Information Management Assoc (AHIMA) Or Certified Coding Specialist
• Physician-based (CCS-P)
• American Health Information Management Assoc (AHIMA) Or Certified Outpatient Coder (COC)
• American Academy of Professional Coders (AAPC) Or Certified Professional Coder (CPC®)
• American Academy of Professional Coders (AAPC) Or Registered Health Information Administrator (RHIA)
• American Health Information Management Assoc (AHIMA) Or Registered Health Information Technician (RHIT)
• American Health Information Management Assoc (AHIMA)

Benefits

• Paid Parental Leave : we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE).
• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.
• Upfront Tuition Coverage : we provide upfront tuition coverage through FlexPath Funded for eligible team members.