Lead Profesional Coding - Edits

Serves as lead responsible for monitoring, maintaining and coordinating work assignments. Performs ongoing audits of select inpatients and outpatient accounts and provides training to ensure optimum reimbursement and hospital coding compliance. Ensures accurate and appropriate information is documented, coded, and entered into the system(s) in order to meet departmental, hospital and outside agency requirements. This includes appropriate reimbursement, verification, compliance, and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record., 1. Monitors, maintains and coordinates work assignments.

1. Processes daily reports.

2. Performs training and in-service education and serves as a coding expert.

3. Performs audits around charging and coding, as assigned.

4. Works with revenue cycle teams to ensure that accurate, timely coding and optimum reimbursement occurs.

5. Assists the management team in the day-to-day operations of the department, as it pertains to reimbursement, coding, abstracting, productivity, quality and education.

6. Assists with development of coding related policies, procedures, query development, work queues and training materials in conjunction with management.

7. Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified.

8. Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.

9. Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.

10. Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.

11. Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.

12. Monitors on an on-going basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.

13. Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.

14. Interacts with physician and non-physician providers to maximize correct coding initiatives.

15. Analyzes & resolves issues of missing charges and problem accounts by researching information regarding department reimbursement.

PHYSICAL REQUIREMENTS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1 . High School Diploma or Equivalent.

1. Current HIM/Coding Certification through ONE of the following: * American Health Information Management Association (AHIMA)

• A merican Academy of Professional Coders (AAPC)

EXPERIENCE:

1. Four (4) years of medical coding experience.

PREFERRED QUALIFICATIONS:

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

1. Associates degree in Health Information Management, 1. Must be able to sit for long periods of time.

2. Must have visual and hearing acuity within the normal range.

3. Must have manual dexterity needed to operate computer and office equipment.

4. Must be Able to lift, push or pull 10-20 pounds., 1. Must possess excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively.

5. Must possess the knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.

6. Must possess the ability to mentor, educate and train others.

7. Must meet quality and productivity standards.

8. Must be able to concentrate and maintain accuracy during constant interruptions.

9. Must possess the ability to prioritize job duties.

10. Must be able to adapt to changes in the workplace and work assignments.

11. Must possess organizational and time management skills.

12. Must possess the knowledge of anatomy, physiology and medical terminology.

13. Must possess analytical and problem solving skills.

14. Must be proficient in office software programs, including medical record and billing systems.