Lead Professional Coder

rogersbh; Town of Oconomowoc (WI); On-site; USD 90,000 - 120,000; Full time

Job summary

Rogers Behavioral Health is seeking a Lead Professional Coder to oversee the Coding Unit's day-to-day operations, ensure optimal coding and data integrity, and train staff on coding updates, EHR systems, and regulatory requirements. This role acts as a liaison across clinical and administrative teams and leads documentation quality initiatives.

Responsibilities include auditing medical records, assigning ICD/CPT/HCPCS codes, DRG determinations, and developing audit procedures while maintaining

Qualifications

• ICD-10-CM, CPT, HCPCS coding knowledge and DRG assignments.
• Auditing, data integrity, and documentation quality awareness.
• EHR systems familiarity and regulatory compliance awareness.

Responsibilities

• Serve as Coding Liaison and point of contact for coding information.
• Provide feedback, problem resolution, and education to providers and staff.
• Coordinate communication between coding, providers, and administration.
• Conduct onsite coding and documentation education on CPT, E/M, modifiers, ICD-9/10, HCPCS.
• Audit medical records for compliance and develop audit reports.
• Identify opportunities to improve documentation quality and regulatory compliance.

Job description

Summary:

The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit. The Lead Professional Coder will be auditing, coordinating, and ensuring that optimal coding is associated with medical records, data integrity, and quality of documentation is met in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations, in addition to acting as a liaison between clinical and administrative teams such as medical staff, nursing, regulatory, compliance, patient financial services, etc. The Lead Professional Coder is an expert in managing patient health information and medical records, administering computer information systems, collecting and analyzing patient data, and using classification systems and medical terminologies. Possesses comprehensive knowledge of medical, administrative, ethical and legal requirements and standards related to healthcare delivery and the privacy of protected patient information. Interacts with all levels of an organization - clinical, financial, administrative, and information systems - that employ patient data in decision‑making and everyday operations.

The Lead Professional Coder is responsible for maintain accurate and up-to-date procedures, training new employees, providing ongoing training on coding, data integrity, quality, regulatory updates, Electronic Health Records (EHR) and related applications, leading efforts on improving documentation quality, compliance, and providing on-site back‑up for the Health Information Manager. The Lead Professional Coder will serve as a subject matter expert for coding, Diagnosis‑Related Group (DRG) reimbursement, and ongoing regulatory compliance review including documentation reviews in the electronic medical record. This position must provide exceptional customer service and leadership for the team. Operates under minimal supervision.

Job Duties & Responsibilities:

• Coding Liaison.
• Serves as the key point of contact for coding information.
• Provides feedback and problem resolution.
• Coordinates communication and process information between coding, providers, and administration.
• Provides onsite coding and documentation education and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payer requirements and insurance rejection resolution.
• Coordinates responses to provider questions along with Compliance and Clinical Informatics team members.

Applies the appropriate diagnostic and procedural code to patient health records for purposes of document retrieval, analysis and claim processing.

Abstracts pertinent information from patient records. Assigns the International Classification of Diseases (ICD), Clinical Modification, Current Procedural Terminology (CPT) or Healthcare Common Procedure Coding System (HCPCS) codes, creating Ambulatory Patient Classification (APC) or Diagnosis‑Related Group (DRG) assignments.

Obtains acceptable productivity/quality rates as defined per position expectations.

Queries physicians when code assignments are not straightforward or documentation in the record is inadequate, ambiguous, or unclear for coding purposes.

Review of medical records concurrently prior to claim submission.

Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.

Coordinate with Manager and Director to Audit all aspects of Electronic Health Record.

Audit medical records for compliance.

Develop and enhance audit reports for medical records.

Develop and enhance Clinical Documentation Improvement function.

Develop and enhance audit procedures.

Complete weekly and monthly expectation & audit reports for administration.

Identify opportunities for improvement.

• Provides input for the provider newsletters and feedback to the Clinical Adoption team on training issues that need further development.
• Maintains current knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.
• Assist the CTS (Clinical Technology Services) teams in the design and configuration of system enhancements.

Participate in the Rogers Improvement System (RIS) program.

• Gain understanding of the RIS process.
• Apply the RIS model to your department's activities.
• Participate and/or create performance improvement teams that lead to improvement in other Rogers Behavioral Health (RBH) areas.
• Educate and involve self in the system and department's RIS plans.

Assist in promoting a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.

Be open to change and actively support change.

Be open to others' ideas and points of view.

Perform other duties as assigned.

Promote department goals as well as the mission of RB o.

Communicate goals to fellow staff members.

Demonstrate measurable goal achievement.

Maintain department policies and procedures.

Include requirements and guid