Lead Professional Coder

Summary:

The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit. The Lead Professional Coder will be auditing, coordinating, and ensuring that optimal coding is associated with medical records, data integrity, and quality of documentation is met in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations, in addition to acting as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, etc. The Lead Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all levels of an organization - clinical, financial, administrative, and information systems - that employ patient data in decision-making and everyday operations.

The Lead Professional Coder is responsible for maintain accurate and up-to-date procedures, training new employees, providing ongoing training on coding, data integrity, quality, regulatory updates, Electronic Health Records (EHR) and related applications, leading efforts on improving documentation quality, compliance, and providing on-site back-up for the Health Information Manager. The Lead Professional Coder will serve as a subject matter expert for coding, Diagnosis-Related Group (DRG) reimbursement, and ongoing regulatory compliance review including documentation reviews in the electronic medical record. This position must provide exceptional customer service and leadership for the team. Operates under minimal supervision.

Job Duties & Responsibilities:

Coding Liaison.

• Serves as the key point of contact for coding information.
• Provides feedback and problem resolution.
• Coordinates communication and process information between coding, providers, and administration.
• Provides onsite coding and documentation education and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payer requirements and insurance rejection resolution.
• Coordinates responses to provider questions along with Compliance and Clinical Informatics team members.

Applies the appropriate diagnostic and procedural code to patient health records for purposes of document retrieval, analysis and claim processing.

• Abstracts pertinent information from patient records. Assigns the International Classification of Diseases (ICD), Clinical Modification, Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, creating Ambulatory Patient Classification (APC) or Diagnosis-Related Group (DRG) assignments.
• Obtains acceptable productivity/quality rates as defined per position expectations.
• Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.
• Review of medical records concurrently prior to claim submission.
• Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.

Coordinate with Manager and Director to Audit all aspects of Electronic Health Record.

• Audit medical records for compliance.
• Develop and enhance audit reports for medical records.
• Develop and enhance Clinical Documentation Improvement function.
• Develop and enhance audit procedures.
• Complete weekly and monthly expectation & audit reports for administration.

Identify opportunities for improvement.

• Provides input for the provider newsletters and feedback to the Clinical Adoption team on training issues that need further development.
• Maintains current knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.
• Assist the CTS (Clinical Technology Services) teams in the design and configuration of system enhancements.

Participate in the Rogers Improvement System (RIS) program.

• Gain understanding of the RIS process.
• Apply the RIS model to your department’s activities.
• Participate and/or create performance improvement teams that lead to improvement in other Rogers Behavioral Health (RBH) areas.
• Educate and involve self in the system and department’s RIS plans.
  
  

Assist in promoting a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.

• Be open to change and actively support change.
• Be open to others’ ideas and points of view.
  
  

Perform other duties as assigned.

Promote department goals as well as the mission of RB o.

• Communicate goals to fellow staff members.
• Demonstrate measurable goal achievement.
• Maintain department policies and procedures.
• Include requirements and guidelines from external agencies (i.e., Joint Commission, State of Wisconsin).
• Maintain and/or communicate to appropriate party function backlog at a set time.
• Educate new staff regarding regulations or requirements of those functions that relate to their areas or departments, as directed.
• Demonstrate acceptance and training of student interns in the department, as directed.
  
  

Demonstrate understanding of Joint Commission and other regulatory agency compliance regulations.

• Involve self in the learning and application of standards relevant to the department.
• Participate in in-services, seminars and other meetings to increase involvement and awareness of regulations.
• Involve self in the education of other disciplines regarding the department’s regulations.
  
  

Participate in RBH committees, performance improvement team meetings, and team projects, as directed.

• Demonstrate punctuality and preparedness.
• Demonstrate effective communication skills.
• Demonstrate good organizational skills.
• Contribute in a positive, solution-focused manner.
• Attend marketing department meetings as needed, actively participate in discussions, recognize and contribute to activities leading to improvement.
  
  

Conduct self in a professional manner.

• Demonstrate organizational skills that promote timely response to all inquiries and to task completion.
• Communicate with all individuals in a positive and professional manner.
• Attempt to resolve individual issues with peers in a positive, calm manner, with a focus on solution.
• Communicate concerns and provide solutions for same.
• Attend outside seminars and/or educational classes to promote professional growth.
• Demonstrate a positive and professional attitude toward parties outside the hospital (provider relations representatives, managed care contractors, visitors, vendors, etc.)
• Comply with the hospital’s policies and procedures, including Human Resources, Infection Control, and Employee Health policies and programs.
• Project a professional image by wearing appropriate, professional attire.

Additional Job Description:

Physical/Mental Demands:

• Function with a great deal of autonomy.
• Ability to travel by car and/or air and be away from Rogers Behavioral Health for extended periods of time.
• Verbal and hearing ability required to interact with patients and employees. Numerical ability required to maintain records and operate a computer.
• Ability to plan, control and direct all aspects of employee relations. Tact required to interact effectively with employees and professional staff. Logical thinking and discretion required to make decisions in initiating and implementing policies and procedures and standards.
• Must be able to read and communicate through written, verbal and auditory skills and abilities.
• Physically/Mentally able to perform job duties as verified by a physical exam by a licensed physician, per post-employment physical.

Education/Training Requirements:

• Associates degree or five (5) years of equivalent experience working in a health care environment.
• Credentials: Registered Health Information Administrator (RHIA®), Registered Health Information Technician (RHIT®), Certified Coding Specialist (CCS®), Certified Coding Specialist –Physician-based (CCS-P®), Certified Documentation Improvement Practitioner (CDIP®), Certified Professional Medical Auditor (CPMA®), or Certified Professional Coder (CPC®).
• Completion of anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced International Classification of Diseases (ICD) diagnostic/procedural and Current Procedural Terminology (CPT) coding courses, required.
• Minimum of two (2) years’ experience of related coding experience directly applying codes, preferably in a psychiatric setting.
• Proven success in facilitation and training.
• Previous participation in the performance improvement programs, preferred.
• Computer proficiency and working knowledge of software programs, including Windows® packages.
• Valid Wisconsin driver license.

With a career at Rogers, you can look forward to a Total Rewards package of benefits, including:

• Health, dental, and vision insurance coverage for you and your family
• 401(k) retirement plan
• Employee share program
• Life/disability insurance
• Flex spending accounts
• Tuition reimbursement
• Health and wellness program
• Employee assistance program (EAP)

Through UnitedHealthcare, UMR and HealthSCOPE Benefits creates and publishes the Machine-Readable Files on behalf of Rogers Behavioral Health. To link to the Machine-Readable Files, please visit Transparency in Coverage (uhc.com)