Lead Medical Coder

Lead Medical Coder

The Lead Medical Coder serves as a certified professional coder and assists the Medical Coding Office Manager with oversight of daily coding operations. Performs the full range of coding, assigns ICD, CPT, HCPCS, and medical inpatient codes; abstracts data from the record; performs chart analysis, research coding issues; peer reviews; and serves as a medical documentation and coding technical expert to TONHC providers.

Scope of Work:
This position is located within Tohono O'odham Nation Health Care (TONHC). The work involves performing specialized medical record tasks and resolving problems using established processes, coding conventions, and guidelines. Performance of duties reflects directly on patient care by recording services performed on the patient. The incumbent works independently under the general supervision of the Supervisor or designee.

Essential Duties and Responsibilities:

(Depending on the area of assignment, an incumbent may not be required to perform some of the duties listed below):

• Assists with the leadership and guidance to the day-to-day inpatient and outpatient medical coding service and staff.
• Assigns codes to diagnosis and procedures using ICD (International Classification of Diseases), HCPCS (Healthcare Common Procedure Coding System), and CPT (Current Procedural Terminology) codes.
• May be assigned to medical inpatient coding; reviews physician's patient medical documentation and determines the most appropriate corresponding code.
• Performs the full range of coding per current ICD coding conventions and the official coding guidelines under Federal, State, and Cooperating Parties.
• Ensures codes are accurate and sequenced correctly per government and insurance regulations.
• Reviews Electronic Health Record (EHR) data and ensures providers and other clinicians assign the appropriate ICD codes; follows up with the provider on insufficient or unclear documentation.
• Assigns the appropriate CPT code for all outpatient medical, surgical, non-physician professional services, and diagnostic services.
• Utilizes the CPT Assistant or other coding software to assist in the proper use of codes.
• Observes the coding rules established by AMA (American Medical Association).
• Assigns the appropriate HCPCS code for items, supplies, and non-physician services used in reimbursement claims processing.
• Appropriately assigns modifiers to codes and verifies site, unit number, and location of services based on the documentation of the record.
• Assigns and reports codes clearly and consistently supported by physician documentation in the health record.
• Assists and educates physicians and other clinicians in proper documentation practices, further specificity, sequencing, or inclusion of diagnoses or procedures to reflect acuity, severity, and other events.
• Establishes a working relationship with providers; consults physicians and other clinicians for clarification and additional documentation before code assignment when necessary.
• Work with computerized information systems, including an electronic health record, encoding software, the internet, and other software applications.
• Maintains and enhances coding skills, stays abreast of changes in codes, coding guidelines, and regulations.
• Abstracts and enters all data for coding, billing, GPRA indicators and CMS, The Joint Commission (TJC), and the governmental reporting process.
• Abstracts and enters all data into a computer system for statistical purposes, third-party billing, and continuity of patient care.
• Provide analysis of documentation and coding issues regarding areas of concern of the health record, including lack of documentation, legibility, system issues, EHR, and other matters.
• Assists with the formulation of query forms and formats for providers to be used for clarification and documentation.
• Identifies inconsistencies within the medical record and participates in QA functions and peer reviews.
• Participates in developing hospital and health centers coding policies and ensuring coding policies complement the official rules and guidelines.
• Assist with technical issues within the computer systems, including the EHR.
• Assist in maintaining and…