Address
Form of workGENERAL SUMMARY/ OVERVIEW STATEMENT:
The Coding Team Leader, CPBO reports to the Coding Manager or Senior Coding Manager and is responsible for ensuring correct coding of professional services and upholding compliance standards.
PRINCIPAL DUTIES AND RESPONSIBILITIES:
The Coding Team Leader is required to:
Coordinate daily efforts of team members to meet team objectives. Monitor daily reports to ensure effective daily production.
Monitor daily WQ's and shift work among coders as needed to meet daily performance indicators.
Assist manager to create and maintain coding policies and/or billing area instructions as needed. Assist staff to ensure that new procedures/policies are incorporated into daily practice.
Implement and maintain effective coding procedures to ensure compliance with third party payer requirements and ensure revenue is optimized. Make recommendations for changes as needed.
Perform coding and related duties as needed to back fill and cross-cover using established Professional Billing Office and Coding Services policies in an accurate and timely manner. Review medical documentation and system generated charges or paper encounter forms. Appropriately assign CPT, ICD-10, HCPCS II, and modifiers based on documentation and payor requirements. (May be expected to code low, medium, or low complexity work.)
Research, understand, and interpret complex billing rules and regulations for new and existing procedures. Help coders to learn how to research and understand billing and coding rules and regulations.
Demonstrate a commitment and ability to integrate coding compliance standards into daily coding practices. Identify, correct and report coding problems.
Maintain current knowledge of coding, compliance and reimbursement procedures. Review current literature, newsletters, payor policy updates and coding manuals.
Critically think through processes in coding in order to recognize errors and/or problems. Identify, analyze, and escalate issues and problems and propose solutions. Make recommendations for changes to processes to improve efficiency and operations.
Resolve coding edits and denials as needed to meet team goals. Help others to understand reasons for actions on edits and make recommendations for changes to edits for process improvements.
Identify opportunities to reduce denials and enhance revenue. Help others to understand denials and solutions to reduce denials. Identify areas for improvement through edit management, education, automation, bots, and/or other technology.
Provide cross-coverage as needed
Function as a subject matter expert to Professional Billing Office staff and external customers. Research and resolve coding inquiries. Make recommendations for coding policy changes.
Participate in annual code updates, understanding of new codes, and notification to practices and other CPBO staff of new code updates.
Perform Quality Assurance reviews of Coding Specialists as needed, report results to manager, and assign peer to peer QA as appropriate.
Functions as subject matter expert for assigned specialties. Share/transfer knowledge or train co-workers, peers, billing managers on coding.
Stand in for manager as needed to attend minimal meetings and share information with manager.
Develop and maintain division specific coding procedures and/or billing area instructions.
Complete special projects as assigned by manager.
Participate in coding education for providers and co-workers upon request.
Maintain coding certification.
QUALIFICATIONS:
High school diploma required
Course work in anatomy and physiology, medical terminology strongly preferred.
Coding Certification from American Academy of Professional Coders (AAPC) or American Health Information Management Association (AHIMA) is required. Certification may include CPC, COC, CCS, CCS-P.
Additional coding certifications preferred (Specialty and/or related) but not required.
Completion of a Coding Certificate program or Health Information Technology Program or >2 years work experience equivalent required.
A Minimum of 5 years of experience in coding required.
SKILLS/ ABILITIES/ COMPETENCIES REQUIRED:
- Advanced Proficiency in ICD-10, CPT, HCPCS, and modifiers for coding of professional fee services.
- Advanced knowledge of anatomy and physiology, medical terminology and insurance reimbursement policies and regulations.
- Able to code low, medium, and high complexity work.
Excellent written and verbal communication skills and the ability to prioritize and organize work to meet strict deadlines are required.
Understands, retains, and is able to research coding and billing rules, regulations requirements. Is able to help others to understand.
Able to critically think through processes in coding in order to recognize errors and/or problems. Understands reasons for actions on edits and is able to help others to understand reasons for actions on edits. Able to make recommendations for changes to edits for process improvement.
Able to provide feedback to billing managers, physicians, staff, and others independently without guidance from manager.
Proven ability to identify denials, trends, and resolutions. Proven ability to identify areas for improvement through edit management, education, automation, bots, and/or other technology.
Able to share/transfer knowledge or train co-workers, peers, billing managers on coding. Able to provide education with physicians in various size group sessions as needed or requested.
Able to provide cross-coverage of multiple specialties of all complexities.
Able to assist other coders in problems and issues as they arise.
Able to perform peer to peer Quality Assurance reviews in equal or lower complexity areas of expertise.
Accuracy and attention to detail
Proficient with computer applications (MS Office etc), Excellent data entry skills
WORKING CONDITIONS:
The Professional Billing Office is located in the Charlestown Navy Yard campus. Most work is expected to be done remotely, however employee is expected to travel onsite as requested.
