Lead Professional Coder

Rogers Behavioral Health•Oconomowoc, WI

About The Position

The Lead Professional Coder is responsible for the day-to-day operations of the Coding Unit. The role audits, coordinates, and ensures optimal coding, data integrity, and documentation quality in accordance with Rogers Medical Staff bylaws, Joint Commission standards, and federal and state regulations. The Lead Professional Coder serves as a liaison among clinical and administrative teams, including medical staff, nursing, regulatory, compliance, and patient financial services. The position requires expertise in patient health information and medical records, information systems, patient data, classification systems, medical terminology, healthcare requirements, and privacy standards. It interacts with clinical, financial, administrative, and information systems personnel and operates under minimal supervision. The Lead Professional Coder maintains procedures, trains new employees, provides ongoing education on coding, data integrity, quality, regulatory updates, EHR and related applications, and leads efforts to improve documentation quality and compliance. The role provides onsite backup for the Health Information Manager and serves as a subject matter expert in coding, DRG reimbursement, regulatory compliance reviews, and electronic medical record documentation. Exceptional customer service and team leadership are expected. The position applies and audits diagnosis and procedure codes, abstracts information from patient records, performs concurrent medical record reviews, queries physicians when documentation or code assignment is unclear, and monitors coding productivity and quality. It coordinates provider education and coding communications, collaborates on EHR audits and improvements, develops audit and clinical documentation improvement processes, and participates in Rogers Improvement System activities. The role also supports department goals, regulatory compliance, staff education, committees, and performance improvement projects.

Requirements

Associate degree or five years of equivalent experience working in a healthcare environment.
One of the following credentials: RHIA, RHIT, CCS, CCS-P, CDIP, CPMA, or CPC.
Completion of courses in anatomy and physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, and intermediate/advanced ICD diagnostic and procedural and CPT coding.
At least two years of related coding experience directly applying codes; psychiatric-setting experience is preferred.
Proven success in facilitation and training.
Computer proficiency and working knowledge of software programs, including Windows packages.
Valid Wisconsin driver license.
Ability to function with a great deal of autonomy and to plan, control, and direct employee-relations matters.
Verbal, hearing, reading, writing, and auditory communication abilities sufficient to interact with patients and employees and perform job duties.
Numerical ability to maintain records and operate a computer.
Tact, logical thinking, and discretion to interact effectively with employees and professional staff and make decisions involving policies, procedures, and standards.
Ability to travel by car and/or air and be away from Rogers Behavioral Health for extended periods.
Ability to perform job duties as verified by a post-employment physical examination by a licensed physician.

Nice To Haves

Previous participation in performance improvement programs.
Related coding experience in a psychiatric setting.

Responsibilities

Manage the day-to-day operations of the Coding Unit and provide leadership and customer service to the team.
Serve as the key coding contact and coordinate communication among coding staff, providers, and administration; provide feedback and resolve coding issues.
Provide onsite coding and documentation education to providers on CPT, E&M, modifiers, internal codes, ICD-9, ICD-10, HCPCS, annual updates, payer requirements, and insurance rejection resolution.
Coordinate responses to provider questions with Compliance and Clinical Informatics team members.
Assign diagnostic and procedural codes to patient health records, abstract pertinent information, and create APC or DRG assignments as applicable.
Meet coding productivity and quality expectations; query physicians when documentation is inadequate, ambiguous, unclear, or not straightforward for coding.
Review medical records concurrently before claim submission and comply with coding guidelines and reimbursement reporting requirements.
Coordinate with the Manager and Director to audit all aspects of the EHR and medical records for compliance.
Develop and enhance medical record audit reports, audit procedures, and the Clinical Documentation Improvement function.
Complete weekly and monthly expectation and audit reports for administration.
Identify opportunities for improvement and provide input to provider newsletters and feedback to the Clinical Adoption team about training needs.
Maintain current knowledge of Medicare, Medicaid, and other regulatory requirements related to accepted coding policies and standards.
Assist Clinical Technology Services teams with the design and configuration of system enhancements.
Participate in and apply the Rogers Improvement System, including performance improvement teams, departmental plans, and improvement projects.
Maintain department policies and procedures, including applicable external agency requirements and guidelines.
Educate new staff and other disciplines on relevant regulations and requirements, as directed; support student intern training, as directed.
Participate in regulatory education, in-services, seminars, committees, performance improvement meetings, and team projects as directed.
Promote department goals and communicate them to staff; demonstrate measurable goal achievement and maintain or communicate function backlogs as required.
Demonstrate punctuality, preparedness, effective communication, organization, professionalism, and a positive, solution-focused approach to work and workplace issues.
Comply with hospital policies and procedures, including Human Resources, Infection Control, and Employee Health policies and programs.
Perform other duties as assigned.