Physician Coding Lead

Overview

Physician Coding Lead role at Erlanger, with responsibilities spanning coding, auditing, leadership, project oversight, daily coder workflow assignments and quality assurance. Coding scope includes ICD-10-CM, CPT, E/M, HCPCS, procedural coding, professional facility coding, surgery, and diagnostic services. The lead plans and organizes the operations of the Physician Services Coders I, II, and III, monitors coding and auditing, assists with training, designs and presents process improvement initiatives, manages resources to meet organizational goals, and serves as liaison between management and coding staff.

• Review and analyze information in the electronic medical record and/or paper record to accurately code episodes of care across multiple specialty areas.
• Provide various components of coding services to support providers.
• Calculate Professional Fee and/or Facility E/M levels following AMA guidelines for E/M assignment.
• Recognize critical care cases by patient acuity.
• Apply ICD-10-CM diagnosis codes to the highest level of specificity.
• Accurately apply diagnosis and procedure codes utilizing ICD-10-CM, CPT, and HCPCS.
• Interpret coding guidelines for accurate code assignment.
• Maintain understanding of National Correct Coding Initiatives, Local Coverage Determinations, and MUEs.
• Maintain understanding and apply Medicare Teaching Physician Guidelines.
• Apply knowledge of applicable regulatory requirements and institutional guidelines to select appropriate codes and modifiers.
• Identify the impact of documentation on code assignment and reimbursement.
• Align conduct with AHIMA Standards of Ethical Coding and the Company’s Code of Ethics and Business Conduct.
• Adhere to Det Norske Veritas (DNV) and other third-party documentation guidelines to minimize risk.
• Continually improve coding quality and accuracy; maintain coding certifications and current ICD-10-CM, CPT, and HCPCS guidelines and regulatory changes.
• Coordinate with appropriate departments or physicians for clarification of diagnoses, CPT, and/or HCPCS.
• Communicate with physicians and non-physician providers to resolve conflicting documentation to specify codes for diagnoses, surgeries, and procedures.
• Provide ongoing feedback to physicians and other providers regarding coding guidelines and requirements.
• Resolve payer denials and respond to inquiries from revenue cycle teams; process charge corrections as appropriate.
• Comply with internal policies and participate in company training and education.
• Ensure compliance with privacy and security rules and protect all confidential information (including PHI).
• Meet or exceed productivity and quality standards as defined by department leadership.

Associate Must Have

• Knowledge of Anatomy and Physiology, Disease Pathology, and Medical Terminology.
• Knowledge of coding conventions and CMS Official Guidelines for ICD-10-CM coding.
• Accurate translation of diagnostic descriptions to assign ICD-10-CM, CPT, and HCPCS codes to optimize reimbursement from all payer types.
• Ability to navigate the Electronic Medical Record to identify documentation for coding/billing.

Education

Required:

Validation of coding certification (e.g., specialty focus such as ICD-10 coding, ICD-10-PCS, CPT, and billing practices) from an accredited program. Preferred: BS or AS in Health Information Management Administration or Health Information Technician from an accredited program.

Experience

Required:

Minimum of five years of coding experience; experience coding in a multi-practice environment; working knowledge of office applications; excellent communication, presentation, and workflow skills; ability to balance quality and quantity of coding; knowledge of DNV or CMS requirements for Physician Billing Practices. Preferred:
Coding management or lead experience in a multi-specialty physician group; auditing experience for coder and physician coding performance.

Department/Position specifics:
Credentialed by AHIMA/AAPC in RHIA, RHIT, CCS, CCS-P, CPC. NHA-CBCS accepted with ability to achieve CPC within 1 year of hire. Specialty coding certification preferred.

• Lead the Physician Coding Department to ensure timely and clinically accurate coding across inpatient, ambulatory, and physician office settings.
• Plan and organize operations to ensure compliance and efficiency; provide leadership for process improvement to reduce costs and meet goals.
• Coach staff, communicate goals and expectations, and monitor productivity and quality.
• Coordinate staff schedules and assist with evaluations, hiring, and disciplinary issues for Coders I-III.
• Monitor the department budget and workload balancing to meet targets.
• Develop, implement, and monitor procedures, guidelines, and coding compliance plans.
• Generate reports on KPIs and act as a liaison to address coding issues with physicians and clinical staff.
• Monitor changes in coding initiatives and regulations to ensure ongoing compliance.
• Conduct routine coding quality audits and develop…