Lead Professional Coder

About the role

The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit. This position audits, coordinates, and ensures optimal coding associated with medical records, data integrity, and quality of documentation in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations. The Lead Professional Coder acts as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, and others. The role requires expertise in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Comprehensive knowledge of medical, administrative, ethical, and legal requirements and standards related to healthcare delivery and the privacy of protected patient information is essential. The Lead Professional Coder interacts with all levels of the organization — clinical, financial, administrative, and information systems — that employ patient data in decision-making and everyday operations. Responsibilities include maintaining accurate and up-to-date procedures, training new employees, providing ongoing training on coding, data integrity, quality, regulatory updates, Electronic Health Records (EHR) and related applications, leading efforts to improve documentation quality and compliance, and providing on-site back-up for the Health Information Manager. The position serves as a subject matter expert for coding, Diagnosis-Related Group (DRG) reimbursement, and ongoing regulatory compliance review including documentation reviews in the electronic medical record. Exceptional customer service and leadership for the team are required, operating under minimal supervision.

Responsibilities

• Serve as the key point of contact for coding information; provide feedback and problem resolution.
• Coordinate communication and process information between coding, providers, and administration.
• Provide onsite coding and documentation education and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payer requirements, and insurance rejection resolution.
• Coordinate responses to provider questions along with Compliance and Clinical Informatics team members.
• Apply appropriate diagnostic and procedural codes to patient health records for document retrieval, analysis, and claim processing.
• Abstract pertinent information from patient records.
• Assign ICD, Clinical Modification, CPT, or HCPCS codes, creating APC or DRG assignments.
• Obtain acceptable productivity/quality rates as defined per position expectations.
• Query physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear for coding purposes.
• Review medical records concurrently prior to claim submission.
• Keep abreast of and comply with coding guidelines and reimbursement reporting requirements.
• Coordinate with Manager and Director to audit all aspects of the Electronic Health Record.
• Audit medical records for compliance; develop and enhance audit reports for medical records.
• Develop and enhance Clinical Documentation Improvement function and audit procedures.
• Complete weekly and monthly expectation and audit reports for administration.
• Identify opportunities for improvement.
• Provide input for provider newsletters and feedback to the Clinical Adoption team on training issues needing further development.
• Maintain current knowledge of Medicare, Medicaid, and other regulatory requirements pertaining to nationally accepted coding policies and standards.
• Assist Clinical Technology Services (CTS) teams in the design and configuration of system enhancements.
• Participate in the Rogers Improvement System (RIS) program: gain understanding of the RIS process, apply the RIS model to department activities, participate in and/or create performance improvement teams that lead to improvement in other Rogers Behavioral Health (RBH) areas, educate and involve self in the system and department’s RIS plans.
• Assist in promoting a team atmosphere by treating individuals with respect and honesty, using direct communication and active listening skills.
• Be open to change and actively support change; be open to others’ ideas and points of view.
• Perform other duties as assigned.
• Promote department goals as well as the mission of RBH; communicate goals to fellow staff members; demonstrate measurable goal achievement.
• Maintain department policies and procedures; include requirements and guidelines from external agencies (e.g., Joint Commission, State of Wisconsin).
• Maintain and/or communicate to appropriate party function backlog at a set time.
• Educate new staff regarding regulations or requirements of functions that relate to their areas or departments, as directed.
• Demonstrate acceptance and training of student interns in the department, as directed.
• Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations; involve self in learning and application of standards relevant to the department.
• Participate in in-services, seminars, and other meetings to increase involvement and awareness of regulations; involve self in education of other disciplines regarding the department’s regulations.
• Participate in RBH committees, performance improvement team meetings, and team projects, as directed.
• Demonstrate punctuality and preparedness; demonstrate effective communication skills; demonstrate good organizational skills; contribute in a positive, solution-focused manner.
• Attend marketing department meetings as needed, actively participate in discussions, recognize and contribute to activities leading to improvement.
• Conduct self in a professional manner; demonstrate organizational skills that promote timely response to all inquiries and task completion.
• Communicate with all individuals in a positive and professional manner; attempt to resolve individual issues with peers in a positive, calm manner with a focus on solution; communicate concerns and provide solutions.
• Attend outside seminars and/or educational classes to promote professional growth.
• Demonstrate a positive and professional attitude toward parties outside the hospital (provider relations representatives, managed care contractors, visitors, vendors, etc.).
• Comply with hospital policies and procedures, including Human Resources, Infection Control, and Employee Health policies and programs.
• Project a professional image by wearing appropriate, professional attire.

Requirements

Education and training

• Associate’s degree or five (5) years of equivalent experience working in a health care environment.
• Completion of anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced International Classification of Diseases (ICD) diagnostic/procedural and Current Procedural Terminology (CPT) coding courses.

Credentials

• One or more of the following: Registered Health Information Administrator (RHIA®), Registered Health Information Technician (RHIT®), Certified Coding Specialist (CCS®), Certified Coding Specialist – Physician-based (CCS-P®), Certified Documentation Improvement Practitioner (CDIP®), Certified Professional Medical Auditor (CPMA®), or Certified Professional Coder (CPC®).

Experience

• Minimum of two (2) years’ experience of related coding experience directly applying codes, preferably in a psychiatric setting.
• Proven success in facilitation and training.
• Previous participation in performance improvement programs, preferred.
• Computer proficiency and working knowledge of software programs, including Windows® packages.
• Valid Wisconsin driver license.

Physical and mental demands

• Function with a great deal of autonomy.
• Ability to travel by car and/or air and be away from Rogers Behavioral Health for extended periods of time.
• Verbal and hearing ability required to interact with patients and employees.
• Numerical ability required to maintain records and operate a computer.
• Ability to plan, control, and direct all aspects of employee relations.
• Tact required to interact effectively with employees and professional staff.
• Logical thinking and discretion required to make decisions in initiating and implementing policies, procedures, and standards.
• Must be able to read and communicate through written, verbal, and auditory skills and abilities.
• Physically/mentally able to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical.

Benefits

Total Rewards package includes:

• Health, dental, and vision insurance coverage for you and your family
• 401(k) retirement plan
• Employee share program
• Life/disability insurance
• Flex spending accounts
• Tuition reimbursement
• Health and wellness program
• Employee assistance program (EAP)