Lead Coding & Reimbursement Specialist

Job Summary:
The Lead Coder serves as first line support, answers questions for Coding Specialists. The Lead Coder assists with review of appropriateness of post discharge physician queries and provides feedback to the coders. The Lead Coder is responsible for review of claim denials and claim edits related to code assignment as identified by Patient Financial Services. Lead Coder assists with review of inpatient or outpatient medical records to evaluate the diagnosis and procedural code assignment as an accurate and appropriate representation of the documentation and utilization of acute care services The Lead Coder also assists with work queue management. The Lead Coder maintains proficiency in the Official Coding Guidelines for coding and reporting and the AHA Coding Clinics. The Lead Coder will serve as third party for any quality audit disagreement between coder and auditor.
Education:
Required: BS in Health Information Administration or AS in Health Information Technology and CCS credential or Registered Nurse in the State of TN with CCS credential.
Preferred: Masters Degree in Business or health related field
Experience:
Required: The applicant will have at least five years inpatient or outpatient coding experience. The applicant should have experience determining whether physician query is appropriate and writing physician queries. The candidate should have experience with chart review.
Required Skills: The candidate must have proven strong broad-based clinical knowledge and understanding of pathology/physiology of disease processes, excellent written and verbal communication skills and critical thinking skills. He/She must be able to work independently in a time-sensitive environment
Ability to facilitate ongoing communication with coders, CDI specialists, managers and provide the interpersonal skills to build effective relationships with coding staff, health information management and CDI specialist. Computer literacy and familiarity with the 3M Encoder and Microsoft Office Software is required.
Position requirements/Licensure:
Required: BS in Health Information Administration with Certified Coding Specialist (CCS) or AS in Health Information Technology with Certified Coding Specialist (CCS).
DEPARTMENT JOB SUMMARY
The Lead Coding & Reimbursement Specialist is accountable for the initial and ongoing success of work queue management to ensure compliance and revenue related to reimbursement. The Lead Coding & Reimbursement Specialist ensures accounts are coded and billed within appropriate timelines. This position is responsible to maintain departmental policies set forth by Leadership and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations.
This incumbent is to have expert knowledge of accurately assigning ICD-10-CM/PCS codes as well as CPT codes for all aspects of coding performed in Health Information Department.. This list is to include inpatient or outpatient accounts. ICD-10-CM/PCS and CPT code assignments must be consistent with applicable ICD-10-CM Official Guidelines for coding and Reporting, ICD-10-PCS Official Guidelines for Coding and Reporting, AMA's CPT Guidelines, regulatory guidelines and hospital specific bylaws and guidelines.
Incumbent will also perform highly complex and specialized coding, including review analysis. The major challenge of this position is ensuring the accountable coding for each patient type is completed within designated timelines. This position is challenged to keep workflows running smoothly for the department, including charge related items in
Work queues to ensure correct and timely billing.
The Lead Coding & Reimbursement Specialist must abide by the AHIMA Code of Conduct and Standards of Ethical Coding as set forth by AHIMA. The incumbent demonstrates exemplary attention to detail with a thorough understanding of government rules, regulations and areas of scrutiny for potential areas of risk for fraud and abuse in regards to coding and documentation.
Job responsibilities include assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided. Incumbent will also assign accurate present on admission indicators to help with accurate reimbursement of cases.
As the Lead Coder, the ability to assist Level 1, Level 2 and Level 3 coders with coding inquiries is essential. In addition, the Lead Coder must acquire the ability to proficiently identify and troubleshoot Epic Coder queues consistent with requirements of the HIM Leadership and in collaboration with the Patient Financial Services and/or Revenue Integrity Department.
This position will also be involved in collaboration and teamwork with Clinical Documentation Improvement Department regarding maintain excellence in coding skills and to keep abreast of current clinical, coding and documentation trends and developments, regulatory changes and updates, current coding standards and guidelines, and other official reference publications (including but not limited to AHA Coding Clinic), as applicable. The incumbent must consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership.