Coder Lead - Risk Management

American Addiction Centers•Milwaukee, WI

4d•Remote

About The Position

This full-time position supports Risk Management (HCC Coding) and operates Monday through Friday on the 1st shift, working 40 hours a week. The role requires a Coding Certification from either the American Academy of Coders (AAPC) or the American Health Information Management Association (AHIMA). While not required, the CRC certification from AAPC is desired. Advocate Health may approve remote work for individuals residing in specific registered states. The pay range for this position is $30.70 - $46.05 per hour.

Requirements

Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)
Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)
Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience.
Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics.
Knowledgeable in researching coding related topics and issues.
Advanced proficiency of ICD, CPT and HCPCS coding guidelines.
Advanced knowledge of medical terminology, anatomy and physiology.
Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications.
Excellent communication (oral and written) and interpersonal skills.
Excellent organization, prioritization, and reading comprehension skills.
Excellent analytical skills, with a high attention to detail.
Ability to work independently and exercise independent judgment and decision making.
Ability to meet deadlines while working in a fast-paced environment.
Ability to take initiative and work collaboratively with others.

Nice To Haves

American Academy of Coders (AAPC) CRC certification

Responsibilities

Acts as a resource and role model to team members, including training, orienting, providing day-to-day work direction, and giving input on performance.
Assigns, monitors, and reviews progress, quality, and accuracy of work; monitors productivity, maintains appropriate staffing levels, directs efforts, and provides guidance on more complex issues.
Codes routine to complex procedures and diagnoses, including hospital-based or surgery center surgical procedures, using ICD, CPT, and HCPCS coding guidelines, procedures, and protocols for government and commercial payers.
Meets or exceeds department quality and production standards.
Performs informal quality reviews monthly, providing coding education to coding team members for accuracy.
May assist with provider education/orientation regarding policy requirements of federal and state government agencies.
Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures, and protocols.
Detects, reports, and acts as a resource to assist in resolving billing compliance issues.
Serves as liaison between business office, medical records, patient care, and/or coding department by providing feedback to caregivers and leaders.
Responsible for processing denial management claims and addressing patient concerns.
Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit.
Coordinates payer audit reviews and acts as a resource for coding-related audits.
Participates in various department projects, including researching new services, claim scrubbing, quality checks/assessing errors, and presenting demonstrations.
Acts as the system/application administrator, ensuring system integrity and recognizing performance issues.
Performs calibration and troubleshooting procedures and escalates unresolved issues as needed.
Suggests modifications to current policies and procedures to align with insurance payer requirements.
Serves as a subject matter expert in the assigned specialty and actively participates in Coding meetings as a problem solver.
Adheres to organizational and internal department policies and procedures to ensure efficient work processes.
Demonstrates expertise in query guidelines and coding standards.
Follows up and obtains clarification of inaccurate documentation as appropriate.
Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals, and hospitals to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS.
Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.
Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.
Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.
Maintains the confidentiality of patient records.
Reports any perceived non-compliant practices to the coding leader or compliance officer.
Meets and exceeds departmental quality (95% or more) and productivity standards (100%).
Achieves productivity expectations to support discharged not final billed (DNFB).
Assists in the production of annual edit review based on CPT, ICD, and HCPCS changes.
Assists in the development of edits based on publications and society updates.
Performs any other assigned duties as management retains the right to add or change duties at any time.
Answers and prioritizes correspondence at all levels (e.g., coding assistants, coders, leads, supervisors, and managers).

Benefits

Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
Premium pay such as shift, on call, and more based on a teammate's job
Incentive pay for select positions
Opportunity for annual increases based on performance
Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program