Coding Lead

About the role

The Coding Lead position is accountable for responding to escalations from internal coding staff as well as external departments and customers to ensure compliance and revenue related to reimbursement is coded and billed within appropriate timelines. This position is responsible for maintaining departmental standard work and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and state regulations.

Responsibilities

• This incumbent is to have expert knowledge of accurately assigning ICD-10-CM diagnostic and procedure codes for all aspects of professional services coding or facility coding.
• Feedback and correction of ICD-10-CM/PCS and CPT code assignments, corrections and advice must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.
• Other Responsibilities Include Work in collaboration with other Coding Lead staff members and colleagues to facilitate timely completion of critical medical record reviews for coding accuracy as directed or otherwise needed by CDI department, Quality and Compliance department, Business office, Data Integrity department, and other departmental business partners as needed.
• Identify Patient Safety Indicators and Hospital Acquired Conditions as being correctly coded and assist Clinical Documentation teams in making meaningful documentation clarifications.
• Reviews cases coded by staff and contract coders for accuracy and compliance with Coding Clinic and facility guidelines.
• Act as subject matter expert and advocate for coding while maintaining objective.
• Maintain quality of coding, document findings, present feedback to individual coders and report findings to Coding Leadership.
• Serve 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.
• 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.
• Reviews and reconciles reports associated with charge review, work queues, claim edit work queues, monthly write-offs and denial management.
• Stays current on coding and compliance regulatory requirements through professional membership literature, continuing education classes, support, and networking groups.
• Maintains coding certification and attends in-service training as required.
• Identifies and troubleshoots EMR coding queues and encoder workflows consistent with requirements of Coding Leadership.
• Utilizes the appropriate physician clarification process to obtain additional information that provides a codable sign, symptom, or diagnosis and/or physician order.

Requirements

• Expert knowledge and specific details of coding conventions and use of coding nomenclature consistent with CMS' Official Guidelines for Coding and Reporting ICD-10-CM coding.
• Knowledge of Anatomy and Physiology of the human body, Pharmacology, Disease Pathology, and Medical Terminology in order to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures performed.
• Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes and procedural codes to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, private and commercial insurance payers.
• Knowledge of clinical content standards.
• Ability and knowledge of the appeal process to ensure accurate reimbursement.
• Utilize critical thinking and problem-solving abilities.
• Ability to work well with others.
• Uphold a strong work ethic characterized by honesty and dependability.
• Demonstrate personal time management skills, including organization, prioritization, and multitasking.
• Adherence to company policies, procedures, and directives.