Lead Physician Coder, Hybrid Position

Job Summary: The primary responsibilities of the Physician Coding Lead include a combination of coding, auditing, leadership, project oversight, daily coder workflow assignments and quality assurance. Physician coding includes ICD 10 CM, CPT, E/M, HCPCS, Procedural coding, Professional facility coding, surgery, and diagnostic services. The coding lead plans and organizes the operations of the Physician Services Coders, I, II, and III. Responsibilities include monitoring of the coding and auditing in addition to assisting with training. Designing and presenting process improvement initiatives; and managing resources to meet organizational goals and objectives. Serves as liaison between manager and coding staff. Responsibilities Include: - Review and analyze information available in the electronic medical record and/or paper record to accurately code the episode of care in multiple specialty areas - Provide various components of coding services to support our providers. - Calculate ProFee and/or Facility E/M levels by following the AMA guidelines for E/M assignment. - Recognize critical care cases by patient acuity. - Apply ICD-10-CM diagnosis codes to the highest level of specificity available. - Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, CPT, and HCPCS - Interpret coding guidelines for accurate code assignment - Responsibility to maintain an understanding of National Correct Coding Initiatives, Local Coverage Documents, and MUEs. - Responsibility to maintain understanding and apply Medicare Teaching Physician Guidelines. - Applying knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers. - Identify the importance of documentation on code assignment and the subsequent reimbursement impact. - Align conduct with AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct and support the Company's Ethics and Compliance Program. - Adherence to Det Norske Veritas (DNV) and other third-party documentation guidelines in an effort to minimize risk. - Continually improve coding quality and accuracy. - Responsibility for maintaining coding certification and knowledge referencing current ICD-10-CM, CPT and/or HCPCS coding guidelines and regulatory changes. - Contacts the appropriate department or physician office for assistance in obtaining physician clarification of diagnoses, CPT, and/or HCPCS. - Communicates with physician and non-physician providers to resolve conflicting provider documentation to further specify coding of diagnoses, surgeries and procedures documented in the medical record. - Provides ongoing feedback to physicians and other providers - Resolves payer denials and responds to inquiries from revenue cycle teams, and processing of charge corrections as appropriate. - Comply with all internal policies and procedures. - Actively participate in Company provided training and education. - Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information - This position must consistently meet or exceed productivity and quality standards as defined by department Leadership The Associate must have: 1. Knowledge of Anatomy and Physiology, Disease Pathology, and Medical Terminology. 2. Knowledge of basic coding conventions and use of coding nomenclature consistent with CMS Official Guidelines for Coding and Reporting ICD-10-CM coding. 3. Accurate translation of written diagnostic descriptions to appropriately and accurately assign ICD-10-CM diagnostic codes, CPT and/or HCPCS to obtain optimal reimbursement from all payer types, including Medicare/Medicaid, and private insurance payers. 4. Ability to navigate the Electronic Medical Record to identify appropriate documentation for coding/billing in support of submitted department charges. Education: Required: Validation of coding certification, i.e., specialty focus such as ICD-10 coding, ICD-10 PCS, CPT coding, and billing practices from an accredited program. Preferred: BS or AS degree in Health Information Management Administration or Health Information Technician from an accredited program. Experience: Required: - Minimum of Five years coding experience. - Knowledge and experience in coding in a multi-practice environment. - Demonstrable working knowledge of office applications (i.e.: Word, Excel, e-mail) required. - Excellent communication, presentation and process workflow skills. - Demonstrates sound judgement and organizational ability. - Possesses ability to balance quality of the coding product with quantity. - Experience in or knowledge of DNV or CMS requirements for Physician Billing Practices. Preferred: - Coding management or lead experience in a multi-specialty physician group. - Experienced in auditing both coder and physician coding performance. Position Requirement(s): License/Certification/Registration Required: Credentialed by AHIMA/AAPC in one of the following: RHIA, RHIT, CCS, CCS-P, CPC. Preferred: Specialty coding certification Department Position Summary: - The Lead of the PB Coding Department ensures the timely and clinically accurate coding of diagnoses and procedures for patients receiving physician services in the inpatient, ambulatory, and physician office setting. - Plans and organizes the operations of the Clinic Coders in a manner that is compliant and efficient. - Provides leadership for process improvement and redesign to reduce costs and meet departmental and institutional goals and objectives. - Coaches coding staff and effectively communicates goals, standards, and coding expectations and meeting goals related to both quality and productivity. - Coordinates employee schedules for adequate coverage to meet departmental goals. - Assists the manager with overseeing Coders I, II, and III, including having input into employee evaluations, hiring and disciplinary issues. - Assists the manager with monitoring the operating budget for the Clinic Coding Department. - Continually reviews workflows and processes to balance workload in the Coding Department to meet targets for completion of coding. - Develops, implements, and monitors procedures, guidelines, and coding compliance plans. - Generates and submits reports to Management on the Clinic Coding Key Performance Indicators (KPI). - Acts as a resource for the Coding staff as well as serves as a liaison in the organization to address clinical coding related issues and questions. - Monitors and disseminates changes in correct coding initiatives; AHA Coding Clinic; CPT Assistant; and other laws, regulations, and policies that impact clinical documentation, reimbursement, and coding to ensure compliance. - Benchmarks performance and/or standards against local and national standards. - Performs/Manages routine coding quality audits for compliance on mandated coding standards for diagnosis, procedure, and Evaluation & Management level assignment and prepares performance improvement plans based on the audit results. - Collaborates with and educates physicians and clinical staff on coding and documentation guidelines. - Ensure a steady flow of communication between Coding Staff and Providers on coding changes, denials and documentation concerns/needs. - Communicate directly with physician and non-physician providers to resolve conflicting provider documentation and further specify diagnoses and procedures documented within the medical record. - Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements. - Resolves payer denials and responds to inquiries from revenue cycle teams, and processing of charge corrections as appropriate. - Charge entry as required - Navigate software workflows and processes to identify and resolve appropriate electronic rules and create efficiencies. - Participate in training of new coding staff - Prepares reports on topics such as denied claims, documentation or coding issues for review by management.