Certified Coding Lead

St. Croix Regional Medical Center

Job Summary:

This position is responsible for coordinating and monitoring work of coding staff to ensure maximum A/R efficiency while in accordance with correct coding initiative guidelines and regulatory requirements. The lead serves as the first-line resource for coding and provides education on diagnosis and procedural coding as well as documentation requirements. This position is also responsible for reviewing patient records and applies accurate evaluation and management (E&M) codes, ICD-10-CM/PCS codes, Current Procedural Terminology (CPT), and Healthcare Common Procedure Coding System (HCPCS) codes in accordance with official coding guidelines and regulatory requirements. Applies knowledge of medical terminology, disease processes, and pharmacology. Demonstrates tested data quality and integrity skills. Provide feedback to providers and work coding specific denials.

Job Description:

  1. Assisting with coding of clinic visits, outpatient services, inpatient professional fees/facility fees, and surgical procedures
    • Accurately assign correct ICD-10-CM/PCS, CPT and HCPCS, including modifiers for designated service lines
    • Follows correct coding initiative guidelines and adheres to regulations governing correct coding.
  2. Communicates with providers and clinical staff on correct coding initiatives and documentation requirements
    • Interacts with medical staff in various settings to optimize and improve documentation.
    • Collate, transfer and analyze audit results to capture and illustrate risk issues, revenue leakage and educational opportunities.
  3. Work with coding/billing team on denials and claim edits
    • Will work coding specific denials, following official coding guidelines and correct coding initiative (CCI) edits ensure bill is coded appropriately
    • Will work denial questions from coders, work with billing staff to resolve outstanding denials with coding questions
  4. Serves as a resource to all partners relative to official coding guidelines to ensure compliance
    • Understands the impact of clinical workflows on revenue cycle functions.
    • Understands charting tools within Excellian (i.e. order entry, smart sets), diagnosis assignment, and the dropping of charges.
  5. Provides quality customer service and communication to all departments, providers, coworkers and all other entities where there is interaction
    • Communication/customer service are delivered in a respectful and professional manner
    • Demonstrates the ability to deal with pressure, meet deadlines and be adaptable in changing situations
  6. Monitors coding workflow, implements process improvements for problematic issues with team/supervisor
    • Serves as the first line of support for Certified Coding Specialists
    • Identifies when additional information is necessary and seeks clarification on any issue
    • Maintains assignments for Certified Coding Specialists and coordinates temporary backup
    • Provides guidance/expertise on process improvement to resolve issues
  7. Maintenance of coding department policies and procedures
    • Develop/updates procedure manuals to maintain standards for correct coding in assigned service lines
  8. Conducts the training, growth, and development of staff members
    • Provide training for new Certified Coding Specialists and current staff
    • May provide orientation and training to other medical center staff relative to coding processes and procedures.
  9. Keep up to date with coding guidelines and regulations
    • Reads bulletins, newsletters, and periodicals and attends webinars to stay abreast of issues, trends, and changes in laws and regulations governing coding and documentation

While this job description is intended to be an accurate reflection of the job requirements, management reserves the right to modify, add or remove duties from particular jobs and to assign other duties as necessary.

Education & Licensure:

  • Associates degree in Health Information Technology/Management, Healthcare Administration or equivalent work experience, required
  • Certification through AAPC (CPC, COC, CIC) or AHIMA (RHIA, RHIT, CCS, CCS-P) required

Apply Online: http://www.scrmc.org