Lead Medical Coder

Job Purpose

The Lead Coder will code all patient types as needed; inpatient, swing bed, same‑day surgery, ancillary, ambulatory and provider‑based clinics, and will mentor, train, and assist coding staff, including newly hired staff. They must review 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.

• Ensures that coding compliance initiatives are met with all record types.
• Conducts regular internal coding audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures and education as needed.
• Assists with productivity reporting and reducing DNFC.
• Coding complex outpatient or inpatient accounts utilizing encoder software and references in the assignment of ICD‑10‑CM/PCS, CPT/HCPCS codes, DRG, POA assignments, APC assignment and all required modifiers.
• Validates charges by comparing charges with health record documentation as necessary, adding procedure and professional charges as appropriate.
• Identifies concerns and notifies appropriate leadership for resolution; responsible for providing resolution to moderate to complex problems.
• Tracks issues (e.g., 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 the coding department.
• Adheres to 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, and other policies and procedures to ensure adherence in a manner reflecting honest, ethical and professional behavior.
• Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, ICD‑10‑CM/PCS diagnostic and procedural coding including CPT/HCPCS and DRG or APC grouping coding principles and guidelines.
• Experience utilizing coding references, encoder software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
• Ability to use standard desktop and Windows‑based computer systems, including a basic understanding of email, internet and computer navigation.
• Maintains a high level of accuracy in code assignment to prevent claim denials, billing errors and potential legal issues.
• Communicates effectively with clinical staff, physicians, office staff and Clinical Documentation Improvement Specialists to clarify documentation, resolve coding‑related queries and ensure accurate and timely claim submission and reimbursement related to inpatient, outpatient or ambulatory coding.
• Participates in ongoing education, training and certification programs to enhance coding proficiency and maintain credentials.
• Upholds professional ethics, integrity and confidentiality in handling patient information.
• Extensive knowledge of hospital and professional coding including provider‑based billing.

• Supports the mission, vision and goals of Avem Health Partners and serves as a role model within the company.
• Exhibits positive customer service behavior in everyday work interactions.
• Demonstrates a courteous and respectful attitude to internal workforce and external customers.
• Communicates accurately and appropriately.
• Handles difficult situations discreetly and professionally.
• Holds self‑accountable for professional practice.
• Participates in performance improvement activities to support and improve departmental goals.
• Demonstrates knowledge of unit goals and actively participates in committees and projects to achieve these goals.
• Keeps current with literature regarding changing practices, interventions and best practices.
• Assumes responsibility for seeking out educational and professional opportunities for personal learning and growth, and for…