Medical Coder - Lead

Title: Medical Coder - Lead

Department: HIM - Medical Records

Reports to: Manager - Coding and Data Quality

Job Code/Cost Center: 10000-50072-003015

FLSA Status: Non - Exempt

Position Objective:

The Medical Lead Coder under the supervision of the Manager of Coding and Data Quality In accordance with Luminis Health coding guidelines, ICD-10-CM Official Coding Guidelines for Coding and reporting and other authoritative resources assists with oversight of daily Inpatient coding operations. This may include work volume and distribution, workflow evaluations and testing. This position may also include reviewing and reconciling reports, providing coding training within the Coding Department, and performing research on coding issues.

Inpatient Essential Job Duties:

1. Review Inpatient medical records, including patient histories, examination findings, diagnoses, and treatment plans, to extract pertinent information for code assignment. Assign the principal and significant secondary ICD-10-CM diagnosis codes, in addition to present on admission indicators, and ICD-10-PCS procedure codes, using official coding guidelines and knowledge of anatomy and physiology, pharmacology and pathophysiology/disease processes. Ensure compliance with coding guidelines, conventions, and regulatory requirements, including adherence to HIPAA (Health Insurance Portability and Accountability Act) privacy regulations.
2. Utilize coding references, software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
3. Maintain a high level of accuracy in code assignment to prevent claim denials, billing errors, and potential legal issues.
4. Stay updated with coding changes, industry trends, and regulatory updates to ensure coding practices align with the latest guidelines and requirements.
5. Collaborate with healthcare providers, billing staff, and other stakeholders to clarify documentation, to resolve coding-related queries, and to ensure accurate and timely claim submission and reimbursement.
6. Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials.
7. Uphold professional ethics, integrity, and confidentiality in handling patient information.
8. Communicate and collaborate with healthcare providers to clarify documentation, obtain necessary information for accurate code assignment, and resolve coding-related queries.
9. Ensure documentation supports the codes assigned and accurately reflects the services provided to maintain compliance with coding guidelines.
10. Stay updated on changes to coding regulations, payer requirements, and industry trends to ensure coding practices align with the latest standards.
11. Analyze complex medical scenarios and make informed decisions regarding code selection based on the documentation provided.
12. Conduct regular audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures as needed.
13. Generate reports and provide coding-related data analysis to support healthcare management and decision-making.
14. Stay informed about coding compliance standards and assist in the development and implementation of coding policies and procedures.
15. Collaborate with the revenue cycle team to ensure seamless billing and reimbursement processes.
16. Serve as a resource for coding-related questions and provide guidance to colleagues and team members as needed.
17. Actively participate in coding team meetings, departmental meetings, and professional development activities to share knowledge, exchange best practices, and contribute to the growth of the coding team.
18. Adhere to professional coding ethics and standards, including maintaining patient confidentiality and privacy.
19. Provide support during external coding audits, including cooperating with auditors, providing documentation, and addressing any findings or recommendations.
20. Assist with the implementation of coding-related software, updates, and system enhancements to optimize coding processes.
21. Maintain a positive and collaborative working relationship with healthcare providers, billing staff, and other stakeholders to foster effective teamwork and communication.

Outpatient Essential Job Duties:

1. Review Outpatient medical records, including patient histories, examination findings, diagnoses, and treatment plans, to extract pertinent information for code assignment.
2. Assign accurate codes to diagnoses, procedures, and services rendered using coding systems such as ICD (International Classification of Diseases) and CPT (Current Procedural Terminology).
3. Ensure compliance with coding guidelines, conventions, and regulatory requirements, including adherence to HIPAA (Health Insurance Portability and Accountability Act) privacy regulations.
4. Utilize coding references, software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
5. Maintain a high level of accuracy in code assignment to prevent claim denials, billing errors, and potential legal issues.
6. Stay updated with coding changes, industry trends, and regulatory updates to ensure coding practices align with the latest guidelines and requirements.
7. Collaborate with healthcare providers, billing staff, and other stakeholders to clarify documentation, to resolve coding-related queries, and to ensure accurate and timely claim submission and reimbursement.
8. Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials.
9. Uphold professional ethics, integrity, and confidentiality in handling patient information.
10. Communicate and collaborate with healthcare providers to clarify documentation, obtain necessary information for accurate code assignment, and resolve coding-related queries.
11. Ensure documentation supports the codes assigned and accurately reflects the services provided to maintain compliance with coding guidelines.
12. Stay updated on changes to coding regulations, payer requirements, and industry trends to ensure coding practices align with the latest standards.
13. Analyze complex medical scenarios and make informed decisions regarding code selection based on the documentation provided.
14. Conduct regular audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures as needed.
15. Generate reports and provide coding-related data analysis to support healthcare management and decision-making.
16. Stay informed about coding compliance standards and assist in the development and implementation of coding policies and procedures.
17. Collaborate with the revenue cycle team to ensure seamless billing and reimbursement processes.
18. Serve as a resource for coding-related questions and provide guidance to colleagues and team members as needed.
19. Actively participate in coding team meetings, departmental meetings, and professional development activities to share knowledge, exchange best practices, and contribute to the growth of the coding team.
20. Adhere to professional coding ethics and standards, including maintaining patient confidentiality and privacy.
21. Provide support during external coding audits, including cooperating with auditors, providing documentation, and addressing any findings or recommendations.
22. Assist with the implementation of coding-related software, updates, and system enhancements to optimize coding processes.
23. Maintain a positive and collaborative working relationship with healthcare providers, billing staff, and other stakeholders to foster effective teamwork and communication.

Educational/Experience Requirements:

Required Minimum Education. The minimum level of education for this position includes:

High School diploma or equivalent and Medical Coding Education. Preferred bachelor’s degree in health information management,business administration or related field. 

Required Minimum Experience:

Three (3) years of verifiable, progressive coding experience. Preferred more than five (5) years of coding experience in an acute care hospital setting.

Required License/Certifications:

Certification as a Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA) required. Preferred Registered Health Information Technician (RHIT), Registered Health information Administrator (RHIA).

Knowledge, Skills, Abilities:

Working Conditions, Equipment, Physical Demands:

Light work. Exerting up to twenty pounds of force occasionally, and/or up to ten pounds of force frequently, and/or a negligible amount of force constantly to move objects. If the use of arm and/or leg controls requires exertion of forces greater than that for sedentary work and the worker sits most of the time, the job is rated for light work.

There is reasonable expectation that employees in this position will not be exposed to blood-borne pathogens.

The above is intended to describe the general content of and requirements for the performance of this job. It is not to be construed as an exhaustive statement of duties, responsibilities, or requirements.

Luminis Health Benefits Overview:
•    Medical, Dental, and Vision Insurance
•    Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
•    Paid Time Off
•    Tuition Assistance Benefits
•    Employee Referral Bonus Program
•    Paid Holidays, Disability, and Life/AD&D for full-time employees
•    Wellness Programs
•    Employee Assistance Programs and more
*Benefit offerings based on employment status

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