Lead Medical Coder

Lead Medical Coder

Fully Remote Home Office - Oklahoma City, OK 73134

Overview

Level: Experienced Position Type: Full Time Job Shift: Day Education Level: Certification Travel Percentage: None Category: Health Information Management (HIM)

Description

Essential functions include but not limited to:

• 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.
• Assist with productivity reporting and reducing DNFC.
• Oversees team coding turnaround times (TAT) performance, identifying root causes of delays, addressing operational barriers, and ensuring adherence to service level expectations.
• Performs accurate coding of Inpatient and Swing bed accounts while consistently meeting established TAT expectations.
• Ensures consistent coding coverage by providing backup and/or redistributing workloads as needed to maintain productivity and meet TAT expectations.
• Collaborate with IT and EHR vendors promptly to quickly identify and resolve system-related issues, minimizing downtime and ensuring timely coding completion.
• Coordinate with IT to ensure timely quarterly coding updates and validate any required testing to ensure system integrity and uninterrupted coding operations.
• Queries physicians as necessary to clarify missing, ambiguous, incomplete or conflicting documentation in the medical record in order to facilitate complete, accurate and consistent coding.
• Participate in coding team evaluations, including competency assessments and provide input to support staff development and performance improvement.
• Participate in revenue cycle meetings as needed to provide coding insights, support process improvements, and ensure workflow alignment.
• Utilizes encoder software and references in the assignment of ICD-10-CM/PCS, CPT/HCPCS codes, 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 (i.e. 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 coding department.
• Adheres to confidentiality requirements as they relate to release of any individual or aggregate patient information.
• Maintains knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects 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 system, including basic understanding of email, internet, and computer navigation.
• Maintain a high level of accuracy in code assignment to prevent claim denials, billing errors, and potential legal issues.
• Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist to clarify documentation, to resolve coding-related queries, and to ensure accurate and timely claim submission and reimbursement related to Inpatient, Outpatient, or Ambulatory coding.
• Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials.
• Uphold professional ethics, integrity, and confidentiality in handling patient information.
• Extensive knowledge of hospitals and professional coding including provider-based billing.
• Adheres to work schedule as agreed with management.
• Adheres to all AVEM policies and procedures.
• Performs other duties as assigned.

Behavioral Standards

• Supports the mission, vision, and goals of Avem Health Partners and serves as a role model within the organization.
• Adheres to the Standards of Behavior: Respect/Professional Conduct and Attitude, Integrity, Communication, Professional/Personal Development, Commitment to Partners/Community, and Excellence.
• Exhibits positive customer service behavior in all work interactions; demonstrates a courteous and respectful attitude to the internal workforce and external customers.
• Communicates accurately and appropriately; handles difficult situations in a discreet and professional manner.
• Holds self-accountable for professional practice; takes ownership of self and work performed.
• Interacts effectively with diverse populations in stressful situations resulting from trauma and illness.
• Keeps current with nursing trends, dialysis-specific knowledge, and evidence-based best practices; participates in in-service programs as required.
• Assumes responsibility for seeking educational and professional development opportunities and meeting mandatory education requirements.
• Demonstrates excellent work attendance; actively participates in meetings and training sessions as requested.
• Adheres to the Avem Health Partners Code of Conduct, Standards of Behavior, and all applicable policies and health and safety requirements.

Education, Experience, Certification & Licensure

• 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. Prefer more than five (5) years of coding experience in an acute care hospital setting.
• Certified Coding Specialist (CCS) required or equivalent.

Physical Requirements

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Requirements listed are representative of the knowledge, skill, and/or ability required. Reasonable accommodation may be made to enable individuals with disabilities to perform essential functions; such accommodations must be requested by the employee or applicant to be considered.

• Visual and auditory abilities must be intact to perform duties.