Lead Coder, Hospital OP Coding

About the role

The Coder Lead will code all outpatient types as needed; 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.

Responsibilities

• Navigate the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.
• Utilize encoder software, Computers Assisted Coding (CAC), and reference to assign ICD-10-CM/PCS, CPT/HCPCS codes, MS-DRG, APR-DRG, POA, SOI, ROM assignments, APC assignment and all required modifiers.
• Validate charges by comparing charges with health record documentation as necessary.
• Use retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtained from the health record.
• Communicate effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.
• Identify concerns and notify appropriate leadership for resolution.
• Provide resolution to moderate to complex problems.
• Track issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.
• Maintain coding quality and productivity standards established by coding department.
• Maintain up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Perform other duties as assigned by leadership.

Requirements

• Minimum three (3) years of current complex outpatient and inpatient coding.
• Completion of an American Health Information Management Association (AHIMA) approved coding program or an American Academy of Professional Coders (AAPC) approved coding program.
• Associate degree in health information management or related field or an equivalent combination of years of education and experience.
• Certified Coding Specialist (CCS) certification from AHIMA or AAPC.
• Certified Inpatient Coder (CIC) certification from AHIMA or AAPC.
• Certified Professional Coder (CPC) certification from AHIMA or AAPC.
• RHIA/RHIT certification.

Qualifications

• Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding and MS-DRG or APC grouping.
• Experience utilizing encoding/grouping software.
• Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
• Experience in ICD-10-CM/PCS coding and reimbursement training.
• Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
• Experience with concurrent coding reviews.
• Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
• Experience in assisting and identifying learning needs as well as providing training to coding staff.
• Strong analytical abilities and problem-solving skills.
• Excellent oral, written and interpersonal communication skills.
• Able to organize and set priorities to ensure objectives are met in a timely manner.
• Able to adapt to change and handle challenges proactively and with poise.
• Able to effectively collaborate with physicians and managerial staff at all levels.