Lead Coding Specialist

Lead Him Coder

A Lead HIM Coder assists in managing the coding team by educating staff and monitoring all coding functions and work queues. They audit records to improve the accuracy and quality of coding and charging within the team. Serves as a liaison with CDI and physicians to enhance documentation, optimize reimbursement, and support efficient AR performance.

Principal Accountabilities:

• Manages multiple EPIC work queues (WQs) to ensure timely billing and resolution of all encounters within 2–3 days.
• Monitors and audits coder performance, ensuring >/= 95% coding and DRG accuracy through regular reviews, meetings, and feedback sessions.
• Educates and mentors coding staff, providing onboarding for new coders, daily coaching, and monthly team meetings to maintain accuracy and compliance.
• Acts as a liaison between the Coding Division, CDI Program, physicians, and Revenue Integrity to improve documentation, query processes, and charge accuracy.
• Conducts daily coding audits and reviews all PSI, Vizient, and 3M data to validate coding accuracy, case quality, and performance metrics.
• Oversees the DRG validation and denial management program, resolving coding disputes and ensuring documentation supports accurate reimbursement.
• Applies national coding standards and metrics, maintaining expertise in SOI/ROM, AHRQ PSI criteria, NTAP cases, and Medicare reimbursement systems.
• Stays current on industry updates, including Medicare PPS changes, Coding Clinic guidance, and emerging trends such as SDOH and COVID-related coding.
• Drives process improvement initiatives, collaborating with CDI, Quality, and ER leaders to enhance documentation, reduce denials, and improve national quality ratings.
• Performs coding duties as needed, supporting workload balance, reducing discharged-not-billed (DNB) cases, and meeting monthly performance goals.

Qualifications:

Required:

• High School Diploma or equivalent and Medical Coding Education
• Certified Professional Coder (CPC Certification).
• Five (5) years progressive coding experience.

Preferred:

• Associate or bachelor's degree in a healthcare related field.
• More than Seven (7) years of coding experience in an academic medical center.
• Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P) or a Certified Coding Associate (CCA) preferred.