Lead, Coding Quality

 About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals. 

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.  

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES: 
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

The Lead Coding Quality Specialist is responsible for directing the day-to-day work of a small team of coding quality specialists (auditors) who provide internal hospital and physician (provider) auditing. The Lead must have the ability to accurately audit and code (ICD-10-CM, ICD-10-PCS, CPT, HCPCS, Level I & II modifiers) all of the following service types: facility inpatient, emergency room, outpatient surgery, observation, ancillary, recurring therapy, clinic, professional, and billing/coding edit resolution. The Lead will work with multiple facility-specific and state billing and coding guidelines, as well as various Medicare Administrative Contractors nationwide, and will collaborate with the Coding Department on coding audits and training.

Duties:

• Lead a team of coding quality specialists, to include assigning tasks, ensuring deadlines are met, and mentoring and training staff on quality and compliance

• Ensure compliance with departmental standards and coding practices

• Ensure team members are working efficiently and meeting performance expectations

• Conduct regular code reviews to assess quality, compliance, and risk

• Identify coding issues and recommend corrective actions

• Communicate audit findings to staff and management

• Maintain detailed records of audits and outcomes

• Align conduct with AHIMA's Standards of Ethical Coding and the Company's Code of Ethics and Business Conduct and support the Company's Ethics and Compliance Program

• Comply with all internal policies and procedures

• Actively participate in Company provided training and education

• Ensure individual compliance with all privacy and security rules and regulations and commit to the protection of all Company confidential information, including but not limited to, Personal Health Information

• Required to audit the work of the on their aligned team

• Required to audit and code as part of individual responsibility

Qualifications:

• Must have 3+ years of production coding experience. This should include hospital and/or physician practice, inpatient coding experience in addition to prior auditing experience

• Must have one of the following Coding Certifications: Certified Inpatient Coder (CIC); Certified Coding Specialist (CCS)

• Must be certified through either the AAPC (CPC or COC) or AHIMA (CCS or CCS-P)

• Must have an understanding of healthcare billing practices and compliant claims preparation for both governmental and commercial payers

• Regular, predictable, and punctual attendance is required

• Must have working knowledge and experience with systems such as EMR, Billing, etc.

• Must have a phone, reliable internet connection and current coding materials such as CPT and ICD-10-CM coding references

• Will be required to maintain an ongoing productivity level and accuracy rate of 95% or higher

• Will be required to maintain a quality score of 95% or higher

• Must be proficient in Microsoft programs like Excel and Outlook. Examples include:

• Excel: should be able to open and add to a spreadsheet, perform basic formulas like adding or multiplying

• Outlook: should be able to manage emails and schedule and attend meetings

• Ability to communicate effectively and professionally both verbally and in writing

• Ability to coordinate, analyze, observe, make decisions, and meet deadlines

• Demonstrated ability to lead and direct the work of others

• May be required to perform other duties as assigned by Leadership Team Member

Physical Demands:

Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described.

Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.