Coding Lead
TOMAH HEALTH - tomah, WI
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POSITION DETAILS Full-time with benefits; 80 hours in the two week pay period, Monday through Friday 8am to 4:30pm. INTERNAL ONLY JOB SUMMARY The Coding Lead is responsible for coding outpatient and inpatient medical records using Evaluation and Management (E&M), Current Procedural Termination (CPT) and ICD (International Classification of Diseases) 10-CM codes as well as performing deficiency analysis procedures. The Coding Lead will be required to work with billing and coding staff to ensure the accuracy of coding and charges on a variety of accounts. The Coding Lead provides personalized and general documentation and coding education to providers and other coders based off industry standards and individual outcomes. Responsible to work with the Patient Financial Services Department as well as all other departments to resolve denials, research proper coding and billing regulations as well as assist them in finding and implementing resolutions. MAJOR JOB FUNCTION Coding/Charge Review and Correction: Responsible for using E&M, ICD-10-CM, ICD-10 procedure codes and CPT according to the following productivity standards which are measured in minutes per account: Inpatient 1 hr 15 min; Observation 37 min; Palliative 25 min; Emergency Room 10 min; Urgent Care 4 min; Warrens Clinic 2 min; Speciality Clinic 7 min; Sleep Lab 4 min; Infusion Services 2 min; Rehab Services 2 min; Imaging 2.5 min; Lab 2 min; Outpatient Surgery (specifically EGD's, colonoscopies and cataracts) 10 min and Outpatient Surgery 30 min. Goal is to assist in coding coverage as needed including helping coders with overflow accounts, take over wqs to assist coders when out of office to keep up on workload, provide each coder with "relief" time at an interval to be specified by Director, to allow coders time to work on their other duties. Required to keep up with coding skills of each service line in order to effectively fill that role dependent on departmental needs. Resolves National Correct Coding Initiative (NCCI) edits, Local Coverage Determinations (LCDs), National Coverage Determinations (NCDs), along with all coding edits in the elecronic record. Responsible to assist coders, as needed, in completing their coding workques, completing oldest accounts first. Responsible for completing daily deficiency analysis, as needed, including working with providers to obtain signatures or other missing pieces of the medical record for record completion. Remains current with coding and billing changes using available resources (i.e. CPT Assist, Coding Clinic, RWHC Coding Roundtable, American Health Information Association (AHIMA), CorroHealth, MLN matters, etc.) Assists in Identifying problem areas in billing operations and helps determine possible solutions. Submits help desk tickets to improve electronic health record documentation and charging tools to ensure compliance with reimbursement and reporting guidelines. Works directly with Patient Financial Services Department to assist in identifying patterns, trends, and variations in coding and documentation practices; evaluating the root cause; and takes appropriate steps in collaboration with appropriate department to affect resolution or explanation of variances. Auditing/Education/Research: Assists in providing education to facility healthcare professionals in use of coding guidelines, practices and proper documentation techniques. Works with Clinical Documentation Improvement Specialist to assist in educating physicians regarding improvements in documentation to meet established requirements for coding/reimbursement and quality of care issues. Assists with auditing clinical documentation and coded data to validate documentation supports services rendered for reimbursement and reporting purposes. Recommends, and assists in facilitating plan of action. Reviews accounts, charges, claim edits and denials as requested from Patient Financial Services to verify that billed codes and charges have been appropriately identified for each patient visit including Evaluation and Management (E/M), applicable Current Procedural Terminology (CPT) codes, ICD-10-CM diagnosis codes and modifiers in accordance with established coding guidelines. Will utilize all available resources to verify accuracy, including, but not limited to department directors (for specific charging questions within their dept.) CPT Assist, Coding Clinic, RWHC Coding Roundtable, American Health Information Association (AHIMA), CorroHealth, MLN matters, CMS, etc. With Director, prepares and presents education to coders in relation to any new coding or billing requirements either as the information becomes available and/or at dept. Coding Meeting. Facilitate coding audits through the entire audit life cycle (may include choosing and pulling accounts to audit, main contact for auditor, set up review meetings, discuss and document findings with auditor and coders, keep track of findings and follow ups yet to be completed, and finally determine conclusions, recommendations. Work with Director on creating formal findings and recommendations, which will be reported by Director to appropriate committees. Attends all available seminars, education courses and review coding resources, newsletters, etc. to expand knowledge and subsequently provides that education via report to coders using multiple platforms, including but not limited to coding meetings. May be requested orient, train, and mentor new coding staff. Serves as a resource and subject matter expert to coding staff. May be asked to assist in developing coding education for coding process improvements. Utilize incident reporting system to track, trend and follow up. Customer Relations/Communications: Maintains confidentiality, is courteous to all customers, addresses and follows up on all customer concerns. Acts as a liaison for coding issues between departments. Collaborates and communicates with other areas of the department in matters of mutual concern. Communicates effectively by seeking and giving feedback, articulating ideas, listening and sharing information with all stakeholders (intra- and inter-departmentally). Participates in a variety of communication medium to stay abreast of current issues within the department and hospital. Promptly answers the telephone and responds appropriately to requests. Teamwork: Participates in staff meetings, appropriate in-services and competency testing, as requested. Attends hospital meetings such as Revenue Cycle meetings, FMEA meetings and any other meetings where coding and billing are on the agenda. Responsible to complete essential daily tasks of co-workers in their absence. Uses knowledge and skills to teach, coach and/or mentor others in the coding process. Exhibits and approachable, interactive style in relationships. Communicated effectively by seeking and giving feedback, articulating ideas, listening and sharing information with all stakeholders (intra- and inter-departmentally). Seeks and encourages alternative views. Acts with integrity and honesty, being willing to trust others and able to engender trust. Recognizes values and builds on differences and commonalities in people. Miscellaneous: Completes reports as required by the Health Information Services Department. Operates and performs necessary maintenance on equipment. Reports any problems or malfunctions to the Help Desk and supervisor promptly. Performs all other duties as assigned EDUCATIONAL REQUIREMENTS High school diploma or equivalent. Associates Degree in Health Information Technology or related field, coding certificate, or equivalent experience. American Health Information Association (AHIMA) certified Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Certified Coding Specialist (CCS), or Certified Coding Associate (CCA). Three years of professional or hospital coding experience required. Extensive background in medical terminology, basic anatomy and physiology, surgical terminology and pharmacology and disease processes. Knowledge of insurance billing and collection procedures, including CPT and ICD-10. Hybrid work schedule, requiring at least two days a week in facility and any other days needed for in person training or meetings. QUALIFICATIONS/SKILLS Excellent verbal and written communication skills. Excellent human relation skills as demonstrated by the ability to interface positively with all employees. Must have the ability to work with frequent interruptions, under stress and deadlines, with minimal supervision, and to exercise initiative and judgment in analyzing, organizing, planning, prioritizing, scheduling and coordinating work with others. Personal computer and spreadsheet experience required. Microsoft Office experience helpful. Manual dexterity required for computer use. Also needs the ability to stay at one workstation for long periods of time. Proficiency in ICD-10-CM, E&M, and CPT coding in both inpatient and outpatient services. JOB REQUIREMENTS Must occasionally lift and/or move up to 25 pounds. Position involves frequent prolonged typing while sitting in one position for prolonged periods
Created: 2024-10-20