Coding Lead Job at Renown Health

Job Description

The Lead Coding position is accountable for the initial and ongoing success of workque assignment and workflows to ensure compliance and revenue related to reimbursement is coded and billed within appropriate timelines. This position is responsible to maintain departmental policies set forth by Leadership and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations. This incumbent is to have expert knowledge of accurately assigning ICD-9-CM/ICD-10-CM diagnostic and procedure codes for all aspects of facility coding. This list is to include Acute Inpatient, Level II Trauma, Rehab Facility, Skilled Nursing, Home Health as well as Hospice. ICD-9-CM/ICD-10-CM/PCS and CPT code assignments must be consistent with CMS Official Guidelines, regulatory agencies and hospital specific bylaws and guidelines.

Job Responsibility

Accountable for the initial and ongoing success of workque assignment and workflows to ensure compliance and revenue related to reimbursement is coded and billed within appropriate timelines
Responsible to maintain departmental policies set forth by Leadership and keeping abreast of continual changes in coding and billing guidelines and compliance related to reimbursement within federal and State regulations
Must have expert knowledge of accurately assigning ICD-9-CM/ICD-10-CM diagnostic and procedure codes for all aspects of facility coding
Perform highly complex and specialized coding, including review analysis
Ensure the accountable coding for each patient type is completed within designated timelines
Keep workflows running smoothly for the department, including charge related items in workques to ensure correct and timely billing
Maintain departmental policies and bring issues and the need for revised/additional policies and procedures to management attention
Identify and resolve problems, set goals and priorities, and represent the department in a professional manner as well as in the absence of Leadership, as assigned
Assignment of diagnostic codes by proficient analysis and translation of diagnostic statements, physician orders, and other pertinent documentation leading to coding accuracy and abstracting of pertinent data elements from documentation provided
Addresses appeals and complex medical record review needed for insurance denials to facilitate expedient resolution and reimbursement
Participates in mandated Medical Record Review processes
Interprets and applies American Hospital Association (AHA) Official Coding Guidelines to articulate and support appropriate principal, secondary diagnoses and procedures
Ensures that all factors necessary for assigning accurate DRG are present, and that related diagnoses are ranked properly
Assign accurate present on admission indicators
Provides information and responds to inquiries regarding medical documentation and DRG’s to CDI staff including Utilization and Quality Assurance Departments when needed
Knowledge of discharge disposition and reimbursement outcomes
Assist Level 1 and Level 2 Coders with coding inquiries
Proficiently identify and troubleshoot Epic Coder queues and Optum workflows consistent with requirements of the HIM Leadership and in collaboration with the Central Business Office and/or Revenue Integrity Department
Work in conjunction with department Leadership to utilize the appropriate physician clarification process to obtain additional information that provides a codeable sign, symptom, or diagnosis and/or physician order
Adherence to Health Information Management (HIM) Coding policies
Adherence to The Joint Commission (TJC) and other third party documentation guidelines in an effort to continually improve coding quality and accuracy
Responsibility for maintaining coding certification and referencing current ICD-9/ ICD-10 coding guidelines and regulatory changes
Participates in performance improvement initiatives as assigned
Collaboration and teamwork with Clinical Documentation Improvement Department
Consistently meet or exceed productivity and quality standards as defined by the HIM Coding Leadership

Requirements

Must have working-level knowledge of the English language, including reading, writing and speaking English
Bachelors Degree in Health Information Management is preferred
A minimum of 4 or more years of progressively responsible and advanced experience in healthcare coding
Experience in all patient types as well as experience and knowledge of needed compliance criteria for all facility types is required
CCS or RHIA/RHIT with a minimum of four years of facility coding experience is required
Must possess, or be able to obtain within 90 days, the computers skills necessary to complete online learning requirements for job-specific competencies, access online forms and policies, complete online benefits enrollment, etc.

What we offer

Education Assistance
Paid Time Off
401(k) Company Match
Flexible Work Environment

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Coding Lead

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