Lead Coder

General Purpose of Job:

Ensures that coding compliance initiatives are met with all record types. Reviews and analyzes medical records and abstracted data submitted by the coding staff to determine the accuracy of code assignment and adequacy of clinical documentation according to regulatory requirements. Performs frequent internal reviews and education maintenance long-term to ensure accuracy in the ever-changing environment of coding, documentation, quality initiatives, and impact to reimbursement. Can code, train, and educate on all types of outpatient medical records to provide timely coverage in all coding areas helping to ensure accuracy, stability, and efficiency in our revenue cycle. Code surgeries, clinic and hospital visits. Attach diagnosis and CPT codes for billing. Assist with auditing by pulling medical records and billing records, research correct coding rules, keep up with audit schedule including re-audits and new physician education. Assist with productivity reporting and reducing charge lag.  Work with the Coding Manager on various projects as assigned.

Essential Duties and Responsibilities:

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. This job description is not intended to be all-inclusive; employees will perform other related business duties as assigned by the immediate supervisor and/or hospital administration as required.

• Always maintains utmost level of confidentiality.
• Adheres to hospital policies and procedures.
• Demonstrates business practices and personal actions that are ethical and adhere to corporate compliance and integrity guidelines.
• Successfully perform coding quality reviews to validate correct coding and abstracting.
• Provide feedback to coding staff regarding audit results.
• Provide cross-training support to the Coders and Coding Quality Analysts in areas where coding compliance is not met.
• Provide quality reviews as requested from other departments such as Case Management, Quality, and Patient Financial Services.
• Assist with scrubbing claims for errors and correcting claim edits.
• Work with analyst to build edits to prevent denials.
• Ensure accuracy and optimization of quality initiatives such as Potentially Preventable Events, ICD-10, Data Governance, and future initiatives.
• Maintain ongoing communication with management, CDI, and coding staff to ensure coding compliance goals are met.
• Assist CBO management in performing coder education tasks and new employee orientation.
• Assist in preparation of Compliance and Audit reports.
• Assist with new physician education and audit schedule.
• Assist CBO management in the analysis of Compliance and Audit reports.

Education and/or Experience:

• Associate degree (A. A.) or equivalent from two-year college or technical school; or two to three years related experience and/or training; or equivalent combination of education and experience.
• Bachelor's degree (B. A.) from four-year college or university; or two to three years related experience and/or training; or equivalent combination of education and experience.

Certificates, Licenses, Registrations.

• CPC or CCS-P required