Job Purpose The Lead Coder will code all patient types as needed; inpatient, swing bed, same‑day surgery, ancillary, ambulatory and provider‑based clinics, and will mentor, train, and assist coding staff, including newly hired staff. They must review documentation to assign appropriate CPT/HCPCS and ICD‑10‑CM‑PCS diagnosis codes and procedures for hospital and physician (professional) services for inpatient and outpatient records based on knowledge of coding systems.
Essential Functions Ensures that coding compliance initiatives are met with all record types.
Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed.
Assists with productivity reporting and reducing DNFC.
Coding complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD‑10‑CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment and all required modifiers.
Validates charges by comparing charges with health record documentation as necessary, adding procedure and professional charges as appropriate.
Identifies concerns and notifies appropriate leadership for resolution; responsible for providing resolution to moderate to complex problems.
Tracks issues (e.g., missing documentation, charges and physician queries) that require follow‑up to facilitate coding in a timely fashion.
Consistently meets or exceeds coding quality and productivity standards established by the coding department.
Adheres to confidentiality requirements as they relate to release of any individual or aggregate patient information.
Maintains up‑to‑date knowledge of changes in coding and reimbursement guidelines and regulations.
Performs other duties as assigned by leadership.
Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, and other policies and procedures to ensure adherence in a manner reflecting honest, ethical and professional behavior.
Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, ICD‑10‑CM/PCS diagnostic and procedural coding including CPT/HCPCS and DRG or APC grouping coding principles and guidelines.
Experience utilizing coding references, encoder software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
Ability to use standard desktop and Windows‑based computer systems, including a basic understanding of email, internet and computer navigation.
Maintains a high level of accuracy in code assignment to prevent claim denials, billing errors and potential legal issues.
Communicates effectively with clinical staff, physicians, office staff and Clinical Documentation Improvement Specialists to clarify documentation, resolve coding‑related queries and ensure accurate and timely claim submission and reimbursement related to inpatient, outpatient or ambulatory coding.
Participates in ongoing education, training and certification programs to enhance coding proficiency and maintain credentials.
Upholds professional ethics, integrity and confidentiality in handling patient information.
Extensive knowledge of hospital and professional coding including provider‑based billing.
Behavioral Standards Supports the mission, vision and goals of Avem Health Partners and serves as a role model within the company.
Exhibits positive customer service behavior in everyday work interactions.
Demonstrates a courteous and respectful attitude to internal workforce and external customers.
Communicates accurately and appropriately.
Handles difficult situations discreetly and professionally.
Holds self‑accountable for professional practice.
Participates in performance improvement activities to support and improve departmental goals.
Demonstrates knowledge of unit goals and actively participates in committees and projects to achieve these goals.
Keeps current with literature regarding changing practices, interventions and best practices.
Assumes responsibility for seeking out educational and professional opportunities for personal learning and growth, and for meeting mandatory education requirements.
Acts as a preceptor when requested.
Demonstrates excellent work attendance and actively participates in a variety of meetings and training sessions as required.
Adheres to the Avem Health Partners Code of Conduct and Standards of Behavior and complies with established policies and procedures and all health and safety requirements.
Education & Qualifications High School diploma or equivalent and Medical Coding Education. Preferred bachelor’s degree in Health Information Management, Business Administration or related field.
Three (3) years of verifiable, progressive coding experience. Preferred more than five (5) years of coding experience in an acute care hospital setting.
Certification / Licensure Certified Coding Specialist (CCS) required or equivalent.
Physical Requirements To perform this job successfully, an individual must be able to perform each essential job duty satisfactorily. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions if requested. The job requires visual and auditory abilities that must remain intact for performance of duties.
Seniority Level Mid‑Senior level
Employment Type Full‑time
Job Function Health Care Provider
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