Lead Medical Coding Specialist (ER/Facilities)

Emerus

About The Position

The Lead Medical Coding Specialist works in conjunction with the Coding Supervisor to ensure accuracy, consistency and efficiency in relation to code assignment for reimbursement and reporting purposes. The Lead Medical Coding Specialist will complete quality reviews for coding staff in order to validate code and reimbursement assignments. This position is a “working” Lead position and is expected to work alongside staff as well as provide direction.

Requirements

A minimum of a High School Diploma or GED, required
4+ years experience coding ICD-10-CM, HCPCS and CPT codes, required
3+ years supervisory experience, required
Proficiency using Microsoft Office Tools (Microsoft Word, Excel and Outlook)
Proficiency using patient accounting systems and electronic health records, required
Knowledge of all health Insurance Portability and Accountability Act (HIPAA) guidelines and regulations, required
Position requires fluency in English; written and oral communication

Nice To Haves

CPC, CPC-H, CPC-P, CEDC or, CCS, preferred
Experience coding emergency or hospital facility and ancillary services, preferred
Experience coding inpatient and observation services, preferred
Experience in applying IV infusion and injection codes, preferred
Expertise in pathophysiology, anatomy, medical terminology, coding systems, techniques and procedures, preferred

Responsibilities

Assist Coding Supervisor in the supervision of Medical Coding staff for Emergency Facilities, Inpatient, Observation and Ancillary services coding
Assists in managing staffing schedule and departmental overtime
Performs quality review of staff for accuracy/efficiency and identifies charge capture opportunities
Completes metric reporting as required by agreed upon deadlines and assists in month end close processes
In conjunction with the Coding Supervisor, ensures standard metrics are consistently met by coding staff and develops corrective action plans as necessary
Provides training/oversight for new staff
Serves as liaison between Coding Team and Coding Supervisor
Works closely with other Intra-CBO Departments for proper resolution of coding and charge capture items as they relate to claim submission and resubmission of claims.
Management and oversight of coding related claim rejections
Utilizes various reports to ensure proper and timely submission of claims for billing
Compile data reports for Coding Supervisor, CBO Director, Executive Leadership, Medical Directors, and Hospital Administrators as needed
Expected to participate as a team member for record completion on an as needed basis (i.e., provide coverage for weekends, holidays, vacation and if coder productivity falls behind an established expectation. Duties will include:
Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and CPT-4 to include IV infusion and injection codes
Review clinical documentation and diagnostic results to extract data and apply HCPCS and facility level Evaluation & Management codes for billing
Abstract and code diagnoses and procedures from health records by using appropriate classification systems
Attend staff meetings or other company sponsored or mandated meetings as required
Perform additional duties as assigned
Ability to work weekends/holidays and overtime on an as needed basis