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 :

Preferred :

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 :

'235196