Lead Coding Specialist

Atlantic Health System; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

Atlantic Health System seeks a Lead HIM Coder to guide the coding team, educate staff, and monitor all coding functions and work queues. You will audit records to improve accuracy and support AR performance.

This role requires collaboration with CDI and physicians to optimize reimbursement and maintain documentation quality. Responsibilities include managing EPIC work queues, mentoring coders, and leading initiatives to reduce denials while strengthening documentation across departments.

Responsibilities

• Manage EPIC work queues to ensure billing within 2–3 days.
• Audit coder performance to maintain ≥95% coding/DRG accuracy.
• Educate and mentor coding staff; onboard new coders and conduct monthly meetings.
• Collaborate with CDI, physicians, and Revenue Integrity to improve documentation and charge accuracy.
• Conduct daily coding audits and review PSI, Vizient, and 3M data.
• Oversee DRG validation, denial management, and ensure documentation supports reimbursement.
• Stay current on Medicare PPS changes, Coding Clinic guidance, and industry trends.
• Drive process improvements with CDI, Quality, and ER to reduce denials and improve quality ratings.
• Support workload balance and reduce DNB, meeting monthly goals.

Skills

EPIC

Coding accuracy

Auditing

Mentorship

Interdepartmental liaison

Tools

EPIC system

Job description

A Lead HIM Coder assists in managing the coding team by educating staff and monitoring all coding functions and w ork queues. They audit records to improve the accuracy and quality of coding and charging within the team. Serves as a liaison with CDI and physicians to enhance documentation, optimize reimbursement, and support efficient AR performance.

Principal Accountabilities:

• Manages multiple EPIC work queues (WQs) to ensure timely billing and resolution of all encounters within 2–3 days.
• Monitors and audits coder performance, ensuring >/= 95% coding and DRG accuracy through regular reviews, meetings, and feedback sessions.
• Educates and mentors coding staff, providing onboarding for new coders, daily coaching, and monthly team meetings to maintain accuracy and compliance.
• Acts as a liaison between the Coding Division, CDI Program, physicians, and Revenue Integrity to improve documentation, query processes, and charge accuracy.
• Conducts daily coding audits and reviews all PSI, Vizient, and 3M data to validate coding accuracy, case quality, and performance metrics.
• Oversees the DRG validation and denial management program, resolving coding disputes and ensuring documentation supports accurate reimbursement.
• Applies national coding standards and metrics, maintaining expertise in SOI/ROM, AHRQ PSI criteria, NTAP cases, and Medicare reimbursement systems.
• Stays current on industry updates, including Medicare PPS changes, Coding Clinic guidance, and emerging trends such as SDOH and C OVID-related coding.
• Drives process improvement initiatives, collaborating with CDI, Quality, and ER leaders to enhance documentation, reduce denials, and improve national quality ratings.
• Performs coding duties as needed, supporting workload balance, reducing discharged-not-billed (DNB) cases, and meeting monthly performance goals