Professional Coding Specialist Lead (Multispecialties)

WVU Medicine; Lubbock (TX); On-site; USD 55,000 - 75,000; Full time

Job summary

SYSTEM West Virginia University Health System is seeking a lead coder to monitor and coordinate coding work, conduct audits, and ensure accurate documentation for compliant ICD-10, CPT coding and optimal reimbursement.

The role requires a current HIM/Coding certification, 4 years of coding experience, and strong mentoring abilities to train staff across the department. Candidates should meet education and licensing requirements and participate in ongoing professional development.

Qualifications

• High School Diploma or Equivalent.
• Current HIM/Coding Certification through AHIMA or AAPC.
• Four (4) years of medical coding experience.

Responsibilities

• Monitors, maintains and coordinates work assignments.
• Performs audits around charging and coding, as assigned.
• Works with revenue cycle teams to ensure accurate coding and optimum reimbursement.
• Mentors, educates and trains others in coding practices.
• Ensures documentation supports accurate ICD-10, CPT codes and modifiers.

Skills

Communication skills

Analytical skills

Problem solving

Mentoring/education

Organization/time management

Medical terminology knowledge

Education

High School Diploma

HIM/Coding Certification (AHIMA or AAPC)

AS degree in Health Information Management

Tools

Medical record systems

Job description

Serves as lead responsible for monitoring, maintaining and coordinating work assignments. Performs ongoing audits of select inpatients and outpatient accounts and provides training to ensure optimum reimbursement and hospital coding compliance. Ensures accurate and appropriate information is documented, coded, and entered into the system(s) in order to meet departmental, hospital and outside agency requirements. This includes appropriate reimbursement, verification, compliance, and charging with the various coding guidelines and regulatory agencies. Responsible for obtaining accurate and complete documentation in the medical record for accurate coding assignment, severity of illness and risk of mortality for each medical record.

Minimum Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• High School Diploma or Equivalent.
• Current HIM/Coding Certification through ONE of the following:
• American Health Information Management Association (AHIMA)
• American Academy of Professional Coders (AAPC)

Experience

• Four (4) years of medical coding experience.

Preferred Qualifications

EDUCATION, CERTIFICATION, AND/OR LICENSURE:

• Associates degree in Health Information Management

CORE DUTIES AND RESPONSIBILITIES

The statements described here are intended to describe the general nature of work being performed by people assigned to this position. They are not intended to be constructed as an all-inclusive list of all responsibilities and duties. Other duties may be assigned.

• Monitors, maintains and coordinates work assignments.
• Processes daily reports.
• Performs training and in-service education and serves as a coding expert.
• Performs audits around charging and coding, as assigned.
• Works with revenue cycle teams to ensure that accurate, timely coding and optimum reimbursement occurs.
• Assists the management team in the day-to-day operations of the department, as it pertains to reimbursement, coding, abstracting, productivity, quality and education.
• Assists with development of coding related policies, procedures, query development, work queues and training materials in conjunction with management.
• Reviews and accurately interprets medical record documentation from all accounts in order to identify all diagnosis and procedures that affect the current inpatient stay or outpatient encounter and assigns the appropriate ICD-10, CPT, or modifier codes for each diagnosis and procedure that is identified.
• Assures that quality and timely coding, charging and abstraction of accounts are completed daily for assigned specialty areas.
• Maintains and enhances current levels of coding knowledge through quality review, attendance and participation at clinical in-services and coding seminars, internal meetings, study of circulating reference materials, and inclusion of updates to coding manuals.
• Assures the accuracy, quality, and timely review of data needed to obtain a clean bill.
• Contacts physicians or any persons necessary to obtain information required to accurately code assignments. Works and communicates with other offices in any manner necessary to facilitate the billing process.
• Monitors on an on-going basis provider documentation. Performs audits to assess provider coding accuracy and follows up with provider education as needed.
• Provides assistance to Revenue Cycle Operations in claim development functions to resolve problem patient accounts.
• Interacts with physician and non-physician providers to maximize correct coding initiatives.
• Analyzes & resolves issues of missing charges and problem accounts by researching information regarding department reimbursement.

PHYSICAL REQUIREMENTS

• Must be able to sit for long periods of time.
• Must have visual and hearing acuity within the normal range.
• Must have manual dexterity needed to operate computer and office equipment.
• Must be Able to lift, push or pull 10-20 pounds.

WORKING ENVIRONMENT

• Standard office environment.
• Visual strain may be encountered in viewing computer screens, spreadsheets, and other written material.
• May require travel.

Skills And Abilities

• Must possess excellent written and verbal communication skills, as well as interpersonal skills necessary to communicate effectively.
• Must possess the knowledge of related provider healthcare compliance, revenue cycle operations, and auditing techniques required.
• Must possess the ability to mentor, educate and train others.
• Must meet quality and productivity standards.
• Must be able to concentrate and maintain accuracy during constant interruptions.
• Must possess the ability to prioritize job duties.
• Must be able to adapt to changes in the workplace and work assignments.
• Must possess organizational and time management skills.
• Must possess the knowledge of anatomy, physiology and medical terminology.
• Must possess analytical and problem solving skills.
• Must be proficient in office software programs, including medical record and billing systems.

Additional Job Description

Scheduled Weekly Hours

40

Shift

Day (United States of America)

Exempt/Non-Exempt

United States of America (Non-Exempt)

Company

SYSTEM West Virginia University Health System

Cost Center

539 SYSTEM HIM Provider Based Coding Analysis