CLN Coder Lead, Full Time, Days

Overview

Job Summary : Demonstrates through behavior Decatur Morgan Hospital's mission, vision and values.

The Certified Professional Coder Lead is responsible for accurate coding assignments of services performed in a medical office setting, hospital setting or outpatient surgical setting for physician and non-physician providers professional fees. Based upon the provider documentation as well as other supporting clinical documentation / reports where acceptable and appropriate the lead coder using their training, expertise and software tools will assign / confirm diagnoses and procedures as indicated in the patient medical record. Classification systems include Current ICD-10-CM and current CPT edition, current HCPCS Level II and all coding is in accordance with official coding guidelines from the American Medical Association and AAPC – Codify All work is carried out in accordance with the Decatur Morgan approved policies and procedures.

Responsibilities

• Review appropriate provider documentation to determine principal diagnosis, conditions and surgical procedures.
• Assign ICD-10-CM diagnosis and procedure codes for Medicare and non- Medicare patient encounters.
• Assign ICD-10-CM diagnosis codes and CPT procedure codes for outpatient procedures and surgery encounters.
• Assign diagnosis and procedure codes in the correct sequence.
• Utilize technical coding principals and reimbursement expertise to assign appropriate ICD-10-CM diagnoses and procedures.
• Work Alpha II edits as assigned facilitating billing corrections
• Assign correct discharge disposition to all hospital inpatient or observation encounters
• Compile report of incomplete records and monitor pending charge report.
• Compile special reports as requested.
• Coordinate internally with PBO team on billing / coding issues.
• Communicate with physicians to ensure complete, correct medical record documentation.
• Process codes and accounts according to the 2- 3-day rule.
• Assist with recovery audit contractor (RAC) audits.
• Review denied claims and assist with appeal letters as may be necessary.
• Assist in correct assignment of charge description master codes.
• Provide assistance for physician review of records.
• Remain current on coding clinic advice.
• Remain current on CPT assistant advice.
• Assist with medical necessity reviews as needed.
• Meet coding standards of productivity established by Decatur Morgan EPN.
• Demonstrate a high degree of accuracy and attention to detail at all times.
• Collect and analyze special project data.
• Provide accurate and timely information using discretion and protect confidentiality of information.
• Use policy and procedure manuals, and other reference materials, to ensure proper course of action in daily business operations. Coding reference material utilizing AAPC software efficiently and AMA coding guides.
• Maintain a cost-conscious attitude to time usage, materials, and supplies.
• Maintain equipment in proper working order.
• Perform additional duties as assigned.

Qualifications

Minimum Knowledge, Skills, Experience Required :

Education : High School Diploma, GED required. Must have minimum of CPC (Certified Professional Coder) Certification. Additional coder certifications desirable.

Experience : Must possess in-depth knowledge of medical and anatomical terminology, reimbursement principles, EMR, sequencing of diagnoses, and the use of coding software. Prefer a minimum of 1 or more years of active coding within a medical office setting preferably multi-specialty, surgical, OB / GYN other specialties a plus. Ability to communicate fluently with physician and non-physician care providers to question and provide guidance to ensure coding accuracy and compliance. Ability to interact with billing specialists understanding the impact of proper coding on reimbursement and denials.

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