Lead Professional Coder

Rogers Memorial Hospital•Oconomowoc, WI

22h

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. This position manages patient health information and medical records, administers computer information systems, collects and analyzes patient data, and applies classification systems and medical terminology. It requires knowledge of the medical, administrative, ethical, and legal standards related to healthcare delivery and the privacy of protected patient information. The role interacts with clinical, financial, administrative, and information-systems teams and operates under minimal supervision. The Lead Professional Coder maintains current procedures, trains new employees, provides ongoing education on coding, data integrity, quality, regulatory updates, EHRs, and related applications, and leads efforts to improve documentation quality and compliance. The role provides on-site backup for the Health Information Manager and serves as a subject matter expert in coding, DRG reimbursement, and regulatory compliance reviews, including documentation reviews in the electronic medical record. Exceptional customer service and team leadership are expected.

Requirements

Associate degree or five years of equivalent experience working in a healthcare environment.
At least two years of related coding experience directly applying codes; psychiatric-setting experience is preferred.
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, intermediate/advanced ICD diagnostic and procedural coding, and CPT coding.
Proven success in facilitation and training.
Computer proficiency and working knowledge of software programs, including Windows packages.
Valid Wisconsin driver license.
Ability to travel by car and/or air and be away from Rogers Behavioral Health for extended periods.
Ability to function with substantial autonomy; plan, control, and direct employee-relations matters; and use tact when interacting with employees and professional staff.
Ability to use logical thinking and discretion when making decisions about policies, procedures, and standards.
Verbal, hearing, reading, written, auditory, and numerical abilities sufficient to interact with patients and employees, maintain records, and operate a computer.
Physically and mentally able to perform job duties, as verified by a licensed physician’s post-employment physical.
Demonstrate punctuality, preparedness, effective communication, good organization, professionalism, and timely task completion.

Nice To Haves

Previous participation in performance-improvement programs.
Experience coding in a psychiatric setting.

Responsibilities

Lead day-to-day operations of the Coding Unit and provide leadership and customer service to the team.
Serve as the coding liaison and key point of contact; coordinate communication and processes among coding staff, providers, and administration, and provide feedback and problem resolution.
Provide on-site coding and documentation education and feedback to providers on coding changes, annual updates, payer requirements, and insurance rejection resolution; coordinate provider-question responses with Compliance and Clinical Informatics.
Apply diagnostic and procedural codes to patient health records; abstract pertinent information; assign ICD, CPT, and HCPCS codes and create APC or DRG assignments.
Meet productivity and quality expectations, query physicians when documentation or code assignment is unclear, and review medical records concurrently before claim submission.
Keep current with coding guidelines and reimbursement reporting requirements, and maintain knowledge of Medicare, Medicaid, and other applicable regulatory requirements and coding standards.
Coordinate with the Manager and Director to audit electronic health records and medical records for compliance; develop and enhance audit reports, audit procedures, and the Clinical Documentation Improvement function.
Complete weekly and monthly expectation and audit reports for administration and identify opportunities for improvement.
Provide input for provider newsletters and give the Clinical Adoption team feedback on training needs.
Assist Clinical Technology Services teams with the design and configuration of system enhancements.
Participate in the Rogers Improvement System, apply its model to departmental activities, and participate in or create performance-improvement teams and projects.
Maintain department policies and procedures, including relevant Joint Commission and Wisconsin requirements; communicate functional backlogs to the appropriate party at established times.
Train new staff on applicable regulations and requirements, as directed; support student interns and educate other disciplines about relevant regulations, as directed.
Participate in in-services, seminars, committees, performance-improvement meetings, team projects, and other meetings as directed or needed.
Promote department and organizational goals, communicate goals to staff, and demonstrate measurable goal achievement.
Use respectful, honest, direct communication and active listening; support change, consider others’ viewpoints, and contribute to a positive, solution-focused team environment.
Respond to inquiries and complete tasks in a timely, organized, and professional manner; address concerns constructively and offer solutions.
Attend outside seminars or educational classes to support professional growth.
Comply with hospital policies and procedures, including Human Resources, Infection Control, and Employee Health policies and programs; maintain professional attire and conduct.
Perform other duties as assigned.