Hospital Coding Quality Lead

Major Responsibilities:

• In collaboration with the Coding Quality Managers, participates in the development and execution of the internal coding guidelines, and documentation requirements to ensure compliance with external regulatory and accreditation requirements, consistent quality data for internal purposes, as well as identification, investigation, correction and prevention of risks/violations.
• Establishes work assignments for all team members and and assists in performing quality assurance reviews and training of coding staff.
• This position would oversee the management of the second level review of prebill work queues, assigning prioritization of accounts, implementing strategies and making real-time adjustments based on account acuity and volume.
• Manages the day to day coding volumes to make sure that the DNFB turn around is being met on all prebill work queues. Handles human resources responsibilities for staff including coaching and evaluations.
• Oversees all hospital coding denial and appeal processes. Ensures timely review and response to any third-party payer notification of incorrectly coded claims. This activity will be recorded and trended over time, using the findings to determine whether additional accounts must have a follow-up audit and what additional education is warranted for physicians and/ or coding caregivers.
• Ensures that results of coding quality assurance reviews are shared in an educational manner with individual coders as well as utilized for group education and learning. Ensures that hospital coding errors found are corrected to ensure data quality and when necessary, accounts rebilled to ensure appropriate reimbursement.
• Responsible for overseeing the planning, development and execution of training for new and existing coding team members to ensure all coders have a thorough onboarding, training and are able to maintain a high level of coding proficiency.
• Oversee the development and execution of appropriate coding education materials.
• Identifies any technology learning needs for the coding team, which includes training on software applications utilized including 3M360 and Epic.
• Maintains continuing education credits and credentials by keeping abreast of current knowledge trends, legislative issues and/or technology in Health Information Management through internal and external seminars. Identify opportunities for continuing education for coding team.

Licensure, Registration, and/or Certification Required:

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), and
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or

Education Required:

• Associate's Degree in Health Information Management or Associate's Degree in a related field.

Experience Required:

• Typically requires 7 years of experience in hospital coding for a large complex health care system, which includes hospital coding, denial review and/or coding education functions.

Knowledge, Skills & Abilities Required:

• Demonstrated leadership skills and abilities including organization, prioritization, project management, delegation, team building, customer service, and conflict resolution.
• Demonstrates knowledge of National Council on Compensation Insurance, Inc. (NCCI) edits, and local and national coverage decisions.
• Expert knowledge and experience in ICD-10-CM/PCS and CPT coding systems, G-codes, HCPCS codes, Current Procedural Terminology (CPT), modifiers, and Ambulatory Patient Categories (APC), MS-DRGs (Diagnosis related groups)
• Advanced knowledge in Microsoft Applications, including but not limited to; Excel, Word, Powerpoint,Teams.
• Advanced knowledge and understanding of anatomy and physiology, medical terminology, pathophysiology (disease process, surgical terminology and pharmacology.)
• Advanced knowledge of pharmacology indications for drug usage and related adverse reactions.
• Expert knowledge of coding work flow and optimization of technology including how to navigate in the electronic health information record and in health information management and billing systems.
• Excellent communication and reading comprehension skills.
• Demonstrated analytical aptitude, with a high attention to detail and accuracy.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able to continuously concentrate.
• Position may be required to travel to other sites; therefore, will be exposed to road and weather hazards.
• Operates all equipment necessary to perform the job.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

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