Medical Coder - Lead

Luminis Health • Annapolis, MD

3h

About The Position

The Medical Lead Coder, under the supervision of the Manager of Coding and Data Quality, assists with oversight of daily Inpatient coding operations in accordance with Luminis Health coding guidelines, ICD-10-CM Official Coding Guidelines for Coding and reporting, and other authoritative resources. This role may include work volume and distribution, workflow evaluations and testing, reviewing and reconciling reports, providing coding training within the Coding Department, and performing research on coding issues. The position involves reviewing both Inpatient and Outpatient medical records to extract pertinent information for code assignment, ensuring compliance with coding guidelines, conventions, and regulatory requirements, including HIPAA. The Lead Coder utilizes coding references, software tools, and EHRs for accurate and efficient code assignment, maintains high accuracy to prevent errors, and stays updated with industry changes. Collaboration with healthcare providers, billing staff, and other stakeholders is crucial for clarifying documentation, resolving queries, and ensuring timely claim submission and reimbursement. The role also involves participating in ongoing education, upholding professional ethics, conducting audits, generating reports, assisting with policy development, and serving as a resource for coding-related questions.

Requirements

• High School diploma or equivalent and Medical Coding Education.
• Three (3) years of verifiable, progressive coding experience.
• Certification as a Certified Professional Coder (CPC), Certified Outpatient Coder (COC), Certified Inpatient Coder (CIC), Certified Coding Specialist (CCS), or Certified Coding Specialist Physician-Based (CCS-P), or a Certified Coding Associate (CCA).

Nice To Haves

• Bachelor’s degree in health information management, business administration or related field.
• More than five (5) years of coding experience in an acute care hospital setting.
• Registered Health Information Technician (RHIT).
• Registered Health information Administrator (RHIA).

Responsibilities

• Assist with oversight of daily Inpatient coding operations, including work volume and distribution, workflow evaluations and testing.
• Review and reconcile reports.
• Provide coding training within the Coding Department.
• Perform research on coding issues.
• Review Inpatient medical records, including patient histories, examination findings, diagnoses, and treatment plans, to extract pertinent information for code assignment.
• Assign the principal and significant secondary ICD-10-CM diagnosis codes, in addition to present on admission indicators, and ICD-10-PCS procedure codes, using official coding guidelines and knowledge of anatomy and physiology, pharmacology and pathophysiology/disease processes.
• Ensure compliance with coding guidelines, conventions, and regulatory requirements, including adherence to HIPAA (Health Insurance Portability and Accountability Act) privacy regulations.
• Utilize coding references, software tools, and electronic health records (EHR) to facilitate accurate and efficient code assignment.
• Maintain a high level of accuracy in code assignment to prevent claim denials, billing errors, and potential legal issues.
• Stay updated with coding changes, industry trends, and regulatory updates to ensure coding practices align with the latest guidelines and requirements.
• Collaborate with healthcare providers, billing staff, and other stakeholders to clarify documentation, to resolve coding-related queries, and to ensure accurate and timely claim submission and reimbursement.
• Participate in ongoing education, training, and certification programs to enhance coding proficiency and maintain credentials.
• Uphold professional ethics, integrity, and confidentiality in handling patient information.
• Communicate and collaborate with healthcare providers to clarify documentation, obtain necessary information for accurate code assignment, and resolve coding-related queries.
• Ensure documentation supports the codes assigned and accurately reflects the services provided to maintain compliance with coding guidelines.
• Stay updated on changes to coding regulations, payer requirements, and industry trends to ensure coding practices align with the latest standards.
• Analyze complex medical scenarios and make informed decisions regarding code selection based on the documentation provided.
• Conduct regular audits and quality assurance reviews to monitor coding accuracy, identify areas for improvement, and implement corrective measures as needed.
• Generate reports and provide coding-related data analysis to support healthcare management and decision-making.
• Stay informed about coding compliance standards and assist in the development and implementation of coding policies and procedures.
• Collaborate with the revenue cycle team to ensure seamless billing and reimbursement processes.
• Serve as a resource for coding-related questions and provide guidance to colleagues and team members as needed.
• Actively participate in coding team meetings, departmental meetings, and professional development activities to share knowledge, exchange best practices, and contribute to the growth of the coding team.
• Adhere to professional coding ethics and standards, including maintaining patient confidentiality and privacy.
• Provide support during external coding audits, including cooperating with auditors, providing documentation, and addressing any findings or recommendations.
• Assist with the implementation of coding-related software, updates, and system enhancements to optimize coding processes.
• Maintain a positive and collaborative working relationship with healthcare providers, billing staff, and other stakeholders to foster effective teamwork and communication.
• Review Outpatient medical records, including patient histories, examination findings, diagnoses, and treatment plans, to extract pertinent information for code assignment.
• Assign accurate codes to diagnoses, procedures, and services rendered using coding systems such as ICD (International Classification of Diseases) and CPT (Current Procedural Terminology).

Benefits

• Medical, Dental, and Vision Insurance
• Retirement Plan (with employer match for employees who work more than 1000 hours in a calendar year)
• Paid Time Off
• Tuition Assistance Benefits
• Employee Referral Bonus Program
• Paid Holidays, Disability, and Life/AD&D for full-time employees
• Wellness Programs
• Employee Assistance Programs and more
• Benefit offerings based on employment status

What This Job Offers

• Job Type: Full-time
• Career Level: Senior
• Education Level: High school or GED
• Number of Employees: 501-1,000 employees