Lead Inpatient DRG Coder - Remote

100 LCMC Health

The Coder Lead will code all patient types as needed; inpatient, same-day surgery, ancillary, ambulatory and provider based clinics. This individual will mentor, train and assist with cross training coding staff, includes newly hired coding staff. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and procedures for hospital and physician (professional) services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.

Your Everyday

GENERAL DUTIES

Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.

Codes complex outpatient or inpatient utilizing encoder software, Computers Assisted Coding (CAC), and reference, in the assignment of ICD-10-CM/PCS, CPT/HCPCS codes, MS-DRG, APR-DRG, POA, SOI, ROM assignments, APC assignment and all required modifiers.

Validates charges by comparing charges with health record documentation as necessary.

Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.

Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.

Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.

Tracks issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.

Consistently meets or exceeds coding quality and productivity standards established by coding department.

Adheres to LCMC confidentiality requirements as they relate to release of any individual or aggregate patient information.

Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.

Performs other duties as assigned by leadership.

Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

The Must-Haves

Minimum:

EXPERIENCE QUALIFICATIONS

5 years of current complex outpatient and inpatient coding

EDUCATION QUALIFICATIONS

Associate Degree in health information management or related field or an equivalent combination of years of education and experience

LICENSES AND CERTIFICATIONS

Certified Coding Specialist (CCS)

American Health Information Management Associations (AHIMA) or American Academy of Professional Coders (AAPC)

Certified Professional Coder (CPC)

American Health Information Management Associations (AHIMA) or American Academy of Professional Coders (AAPC)

Internal staff who are not certified must obtain medical coding certification within twelve months through an approved LCMC coding program.

SKILLS AND ABILITIES

Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding and MS-DRG or APC grouping.
Experience utilizing encoding/grouping software.
Ability to use standard desktop and windows-based computer system, including basic understanding of email, internet, and computer navigation.
High ethical standards.
Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
Experience in ICD-10-CM/PCS coding and reimbursement training.
Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
Extensive knowledge of hospital and professional coding including provider-based billing.
Knowledge of documentation regulations of Joint Commission and CMS.
Experience with concurrent coding reviews.
Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
Experience in assisting and identifying learning needs as well as providing training to coding staff.
Strong analytical abilities and problem-solving skills.
Excellent oral, written and interpersonal communication skills.
Ability to organize and set priorities to ensure objectives are met in a timely manner.
Ability to adapt to change and handle challenges proactively and with pose.
Ability to effectively collaborate with physicians and managerial staff at all levels.

WORK SHIFT:

Days (United States of America)

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