Lead Medical Coder

About the role

The Lead Medical Coder serves as a certified professional coder and assists the Medical Coding Office Manager with oversight of daily coding operations. This position is located within Tohono O'odham Nation Health Care (TONHC).

Responsibilities

• Assists with the leadership and guidance to the day-to-day inpatient and outpatient medical coding service and staff.
• Assigns codes to diagnosis and procedures using ICD, HCPCS, and CPT codes.
• Reviews physician's patient medical documentation and determines the most appropriate corresponding code.
• Ensures codes are accurate and sequenced correctly per government and insurance regulations.
• Abstracts and enters all data for coding, billing, GPRA indicators and CMS, The Joint Commission (TJC), and the governmental reporting process.
• Provides analysis of documentation and coding issues regarding areas of concern of the health record, including lack of documentation, legibility, system issues, EHR, and other matters.
• Maintains and enhances coding skills, stays abreast of changes in codes, coding guidelines, and regulations.
• Works with computerized information systems, including an electronic health record, encoding software, the internet, and other software applications.
• Attends meetings and serves as a resource person for coding.
• Serves as a resource for PCC data entry staff, assisting with coding, EHR; and, documentation issues.

Requirements

• High School Diploma or General Education Diploma.
• Three years of work experience in medical coding or billing.
• Six months supervisory or leadership work experience in an office setting.
• Must possess and maintain certification as a Certified Coder certificate from the American Academy of Professional Coders or the American Health Information Management Association, or equivalent.
• Must type 40 WPM.

Qualifications

• Knowledge of the Tohono O'odham culture, customs, and traditions.
• Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
• Knowledge of computer software, including word processing, database, and spreadsheet application.
• Knowledge of legal regulations and requirements on confidentiality, specifically to the Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Knowledge of and skill in applying a comprehensive body of rules, procedures, and operations, such as health information management, medical records activities, and computerized data entry and retrieval systems.
• Knowledge of official coding conventions and guidelines established by the AHIMA, AHA, CMS, NCHS, etc.
• Knowledge of ICD/CM (International Classification of Diseases/Clinical Modification), and HCPCS (Healthcare Common Procedure Coding System), CPT (Current Procedural Terminology) appropriate Level coding.
• Knowledge and understanding of Diagnostic Related Group (DRG) and Ambulatory Patient Classification (APC) systems and associated encoding software applications.
• Ability to abide by and promote compliance with the AHIMA Standards of Ethical Coding and with the Compliance Plan and Coding Compliance Plan of the TONHC Hospital and Clinics; and the Internal Control Policy of IHS.
• Knowledge of the healthcare industry pertains to the functions of the position, capacity, and willingness to obtain continuing education required to maintain certification and stay apprised of changes in coding and the health care industry.
• Knowledge of pharmacology, including the ability to reference the Physician's Desk Reference (PDR).
• Knowledge of the RPMS software program, specifically the PCC, ADT, Scheduling, and EHR applications.
• Knowledge and ability to use computers, scanners, and reference materials for day-to-day tasks within the hospital.
• Knowledge of and ability to conduct chart reviews and coding audits to ensure accuracy and appropriate coding and compliance with rules and regulations.
• Ability to use standardized computer software such as spreadsheets, word processors, electronic email systems, and database software programs.
• Skill and commitment to accuracy and detail.
• Ability to communicate effectively with others, orally and written.
• Ability to prepare reports in a well-written, concise format using applicable software applications.
• Ability to generate reports and analyze data from these systems.
• Ability to establish performance improvement functions, track and report outcomes and conclusions or follow up orally and in writing.
• Ability to organize and plan work.
• Ability to deal with individuals from a variety of diverse backgrounds.
• Ability to work independently, use sound judgment, and meet deadlines.
• Ability to provide accurate reports.

Skills

• Knowledge of the Tohono O'odham culture, customs, and traditions.
• Knowledge of applicable federal, state, tribal laws, regulations, and requirements.
• Knowledge of computer software, including word processing, database, and spreadsheet application.
• Knowledge of legal regulations and requirements on confidentiality, specifically to the Privacy Act of 1974 and Health Insurance Portability and Accountability Act of 1996 (HIPAA).
• Knowledge of and skill in applying a comprehensive body of rules, procedures, and operations, such as health information management, medical records activities, and computerized data entry and retrieval systems.
• Knowledge of official coding conventions and guidelines established by the AHIMA, AHA, CMS, NCHS, etc.
• Knowledge of ICD/CM (International Classification of Diseases/Clinical Modification), and HCPCS (Healthcare Common Procedure Coding System), CPT (Current Procedural Terminology) appropriate Level coding.
• Knowledge and understanding of Diagnostic Related Group (DRG) and Ambulatory Patient Classification (APC) systems and associated encoding software applications.
• Ability to abide by and promote compliance with the AHIMA Standards of Ethical Coding and with the Compliance Plan and Coding Compliance Plan of the TONHC Hospital and Clinics; and the Internal Control Policy of IHS.
• Knowledge of the healthcare industry pertains to the functions of the position, capacity, and willingness to obtain continuing education required to maintain certification and stay apprised of changes in coding and the health care industry.
• Knowledge of pharmacology, including the ability to reference the Physician's Desk Reference (PDR).
• Knowledge of the RPMS software program, specifically the PCC, ADT, Scheduling, and EHR applications.
• Knowledge and ability to use computers, scanners, and reference materials for day-to-day tasks within the hospital.
• Knowledge of and ability to conduct chart reviews and coding audits to ensure accuracy and appropriate coding and compliance with rules and regulations.
• Ability to use standardized computer software such as spreadsheets, word processors, electronic email systems, and database software programs.
• Ability to communicate effectively with others, orally and written.
• Ability to prepare reports in a well-written, concise format using applicable software applications.
• Ability to generate reports and analyze data from these systems.
• Ability to establish performance improvement functions, track and report outcomes and conclusions or follow up orally and in writing.
• Ability to organize and plan work.
• Ability to deal with individuals from a variety of diverse backgrounds.
• Ability to work independently, use sound judgment, and meet deadlines.