Coder - Lead

The Lead Coder, under the direction of the HIM Coding Manager, provides leadership and subject matter expertise to the coding team across inpatient and/or outpatient care settings. This role ensures daily operational functions are met, supports coding quality and compliance, and provides continuity during the training and onboarding of staff. The Lead Coder serves as a super user and resource for both internal and external stakeholders, assisting with complex coding questions, workflow improvements, and regulatory compliance. This position balances hands-on coding responsibilities with mentoring, auditing, and operational oversight to ensure accuracy, timeliness, and compliance in coding practices., + Adheres to the Standards of Ethical Coding as set forth by AHIMA and/or AAPC and remains current with official coding guidelines, regulatory updates, and payer requirements

• Works collaboratively with HIM management to support coding audit processes that promote quality, accuracy, and compliance

• Monitors daily activity of coding work queues to support productivity benchmarks and turnaround times; communicates trends, barriers, or risks to HIM management

• Provides technical guidance, recommendations, and feedback regarding workflow efficiencies, process improvements, and denial prevention opportunities

• Serves as a mentor and resource to coding staff; assists with onboarding, training, and cross-training to support departmental coverage needs

• Collaborates with Patient Financial Services, Revenue Integrity, Compliance, CDI, and other stakeholders to identify and resolve coding-related issues impacting reimbursement or compliance

• Demonstrates advanced technical expertise in ICD-10-CM, CPT/HCPCS, and PCS coding, as well as applicable reimbursement methodologies (e.g., DRG, APC/E-APG)

• Formulates compliant coding queries when provider documentation is incomplete, ambiguous, or unclear

• Assists with review and correction of claim edits, error reports, and denials; identifies error patterns and partners with management on corrective actions

• Provides education and guidance to providers and clinical teams related to documentation, coding, and reimbursement best practices

• Maintains regular hands-on coding responsibilities and supports complex or high-risk case review as assigned

• Escalates operational, compliance, or performance-related concerns to the Coding Supervisor and/or HIM Coding Manager

• Performs other duties as assigned by HIM leadership, S - Sedentary Work - Exerting up to 10 pounds of force occasionally Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.

For disease specific care programs refer to the program specific requirements of the department for further specifications on experience and educational expectations, including continuing education requirements.

Any physical requirements reported by a prospective employee and/or employee's physician or delegate will be considered for accommodations.

• Minimum of 3 years of professional coding experience in inpatient and/or outpatient settings.

• RHIA, RHIT, CCS, or CPC credential.

PREFERRED QUALIFICATIONS:

• Associate's degree.

• Demonstrated knowledge of State, Federal, and payer-specific regulations pertaining to documentation, coding, and billing.

• Advanced knowledge of ICD-10-CM, CPT, and PCS coding guidelines.

• Strong understanding of reimbursement methodologies (DRG, APC/E-APG, etc.) and revenue cycle workflows.

• Proficiency in EHR and coding systems (e.g., Care Connect, UDS, Clintegrity).

• Demonstrated ability to mentor, train, and support staff in coding best practices.

• Excellent problem-solving, communication, and collaboration skills.