Lead Clinical Quality Coder

Overview

Job Summary

Trains team members and performs coding audits. Reviews clinical documentation and diagnostic results as appropriate to extract data and apply appropriate ICD9/10-CM and CPT 4 codes for billing internal and external reporting, research and regulatory compliance. Assists Coding Director, Coding Manager or Coding Supervisor with coding related functions to ensure consistent, high quality coding, MS-DRG, APC, Present on Admission, Patient Safety Indicators, Hospital Acquired Conditions and Core Measures assignments.

Essential Functions

• Trains and orients new team members according to specific guidelines while utilizing the facility encoder, HBOC and EMR.
• Demonstrates the technical competence to use the facility encoder as it interfaces with the hospital mainframe and/or EMR in an on-site or remote setting.
• Demonstrates proficiency with Microsoft Office Applications in using required computer systems with minimal assistance.
• Assists Coding leadership with continuing education for all coding personnel.
• Facilitates peer review and training for Coding personnel.
• Prepares and performs coding audits to ensure consistent, high quality coding, MS-DRG, APC, Present on Admission, Patient Safety Indicators, Hospital Acquired Conditions and Core Measures.
• Resolves error reports associated with billing process, identifies and reports error patterns, and, when necessary, assists in design and implementation of workflow changes to reduce billing errors.
• Assists with rebilling accounts when necessary.
• Coordinates flow of information between coding and other departments, which include Medical Records, Medical Audit, Patient Accounts, Performance Improvement, Corporate Compliance, RAC, DA2, Clinical Care Management and other coding reviews as requested.
• Reviews inpatient and/or outpatient medical records to identify the appropriate principal diagnosis and procedure codes, all other appropriate secondary diagnoses and procedure codes and POA indicator for all diagnosis codes.

Physical Requirements

Must be able to concentrate and sit for long periods of time while reviewing electronic health records. Daily and weekly deadlines must be met in a fast paced office environment and/or at home environment.

Education, Experience and Certifications.
High School Diploma or GED required; Bachelor’s Degree preferred. Advanced knowledge in Medical Terminology, Anatomy and Physiology and Pharmacology. 5 years acute care facility coding and/or supervision required. Ability to work effectively as a trainer/educator while communicating effectively and patiently. Previous auditing and training experience preferred. Current RHIA, RHIT, CPC, CPC-H, CIC or CCS required plus a passing score on the Coding test.