Senior Professional Coder

Albany Medical Center•Albany, NY

2d•$64,972 - $97,458•Remote

About The Position

The Remote Senior Professional Coder applies advanced professional coding expertise as a service-line coding team lead, collaborating on professional fee coding, charging, and denials follow-up workflows. The role coordinates with others to ensure coding processes are completed comprehensively and on time, audits CPT and ICD-10 diagnosis coding for compliance with federal and state regulations and insurance-carrier guidelines, and provides education and training to providers and coding staff. The coder also serves as an expert in HCC and risk-adjustment coding. The position is remote but requires onsite provider education as needed. The role supports the coding team’s daily operations and may assume supervisory tasks in the supervisor’s absence. It contributes to workflow and system improvements, application testing and maintenance, staffing and training activities, department goals, audits, denials management, and external audit coordination. It also performs professional fee coding and chart reviews, identifies coding and documentation improvement opportunities, and communicates findings and recommendations to relevant parties.

Requirements

High school diploma or G.E.D. is required.
Two or more years of prior professional-fee coding experience is required.
CPC, CCA, CCS, COC, RHIT, or RHIA credential is required.
Working knowledge and experience with provider professional-fee coding and charge processing; a complex coding skill set is required.
Computer experience in a Windows environment, with proficiency in Microsoft Word and Excel, is required.
Excellent verbal and written communication skills, with high proficiency.
Equivalent combinations of relevant education and experience may be substituted as appropriate.

Nice To Haves

Knowledge of multiple coding specialties.

Responsibilities

Review, analyze, and validate provider-applied CPT and ICD-10 diagnosis codes and charges for compliance with applicable regulations and insurance-carrier guidelines, while meeting productivity and quality standards.
Assist the supervisor with daily coding-team operations as a team lead and assume supervisory tasks for assigned coding staff when the supervisor is absent.
Perform accurate and compliant CPT and ICD-10 diagnosis coding.
Define and submit coding and edit rules for consideration to improve accuracy and efficiency across interfaced systems.
Participate as a workflow expert in application testing, including developing and processing test scripts, importing charges, and reviewing process accuracy.
Assist with implementation, testing, troubleshooting, and maintenance of third-party vendor application software.
Assist in preparing, overseeing, and approving staff schedules to meet departmental needs.
Orient and train staff, provide feedback, and evaluate staff as needed.
Help establish department goals and support their achievement using LEAN management skills.
Participate in recruiting and interviewing candidates for personnel vacancies.
Perform specified System Manager duties in the system manager’s absence, including compiling and creating daily reports, importing charges, and researching and correcting coding validation errors during charge import.
Assist in creating and updating policies and procedures, including system development and maintenance documentation.
Conduct timely prospective, concurrent, and retrospective medical-record chart reviews to confirm HCC diagnosis coding meets CMS and Official ICD-10-CM coding guideline requirements; code chronic diseases meeting HCC and risk-adjustment criteria and validate missed coding opportunities.
Conduct professional-fee billing-integrity reviews and audits for AMHS, assessing documentation and coding compliance and identifying clinical documentation improvement opportunities.
Identify trends from audit and review findings, recommend follow-up education and corrective actions, communicate findings, and help develop action plans.
Assist with denials management by determining root causes and providing feedback and training to providers and staff to reduce denials.
Liaise with external auditors and organize the audit process; implement changes and education based on findings.
Attend and contribute to PCO staff meetings, department meetings, and other assigned meetings.
Provide work coverage and notify administration during personnel illness, vacation, or education periods, as required by the department.
Maintain professional development through webinars, workshops, and conferences when appropriate.
Work effectively with people from different disciplines and with varying levels of business and technical expertise.
Perform other duties as assigned.