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Professional Coding Lead

Professional Coding Lead

Job LocationsUS-Remote

ID

2023-4024

Category

Revenue Cycle

Position Type

Regular Full-Time

Company Overview

#LI-Remote

Shriners Children’s is a family that respects, supports, and values each other. We are engaged in providing excellence in patient care, embracing multi-disciplinary education, and research with global impact. We foster a learning environment that values evidenced based practice, experience, innovation, and critical thinking. Our compassion, integrity, accountability, and resilience defines us as leaders in pediatric specialty care for our children and their families.

Job Overview

Shriners Children’s is the premier pediatric burn, orthopaedic, spinal cord injury, cleft lip and palate, and pediatric subspecialties medical center. We have an opportunity for a Professional Coding Lead reporting into our Corporate Headquarters.

The Professional Coding Lead performs at an advanced level medical professional coding position and serves as an expert utilizing International Statistical Classification of Diseases (ICD-10) and Current Procedural Terminology (CPT 4) classification system coding to all diagnoses, treatments and procedures in all types of Hospital, Clinic and Ambulatory Surgical Center (ASC) locations at stated minimum performance levels. The Revenue Integrity Professional Coder Team Lead supervises daily operations specific to professional coding and coder productivity. Develop staff coverage strategies to maintain consistent productivity flow and assists to cover staff PTO/position vacancies. Reviews employee timesheets and validates with timecards in the payroll system biweekly. Monitors the Professional Hold Report weekly to ensure coding is completed timely and to request information from responsible departments as well as develop strategies to minimize un-coded accounts greater than the bill hold period. Supports Professional Coding Team by discussing complex coding cases, answering questions, providing education and interfacing with Leadership. Runs daily and weekly status reports and distributes to appropriate parties. Completes edits in Bill scrubber and CBO and identifies payer specific guidelines and process improvement opportunities. Communicates documentation improvement opportunities and coding issues (lacking documentation, physician queries, etc.) to appropriate personnel for follow-up and resolution. The Revenue Integrity Professional Coder Team Lead will also provide training for all new professional coders and monitors staff progress.

Responsibilities

  • Interpret health record documentation using knowledge of anatomy, physiology, clinical disease processes, pharmacology and medical terminology to identify diagnoses and procedures
  • Interpret ICD-10; CPT 4; Healthcare Common Procedure Coding (HCPC) and modifier codes for services rendered accurately and completely
  • Follows coding guidelines and legal requirements to ensure compliance with federal and state regulations
  • Identifies trends in documentation deficiencies and presents along with creative solutions
  • Acts as a key liaison for the clinical staff as it relates to coding and compliance
  • Interacts with Physician and Executive Leadership and other professional staff of documentation issues relating to coding data
  • Acts as a mentor to Professional Coding team
  • Reviews employee timesheets and validates with timecards in the payroll system biweekly
  • Manages Professional Coding Team schedule including PTO and coverage
  • Provides onboarding system and workflow training to newly employed coders
  • Performs 100% audit for all newly employed coders and provides feedback
  • Monitors staff quality performance and provides education to support correct coding
  • Prepares and presents education in conjunction with the Revenue Integrity Professional Coding Educator
  • Primary contact for Revenue Cycle and Clinical teams throughout Shriners Hospitals for Children (SHC) system to assist with coding questions
  • Prepares and distributes queue status reports to Coding Leadership on a daily and weekly basis
  • Performs scheduled surgical audits for Provider feedback and communicates results to Surgeons
  • Bill Scrubber coding WQ Edits and trends results
  • Professional Coding WQ and trends denial reasons

Qualifications

Experience:

  • 7 years of professional coding experience required
  • Experienced with Surgery Coding Guidelines, E/M Coding Guidelines, CPT coding, ICD-10, HCPCS and NCCI Edits required
  • Pediatric, orthopedic and/or injury, and burn coding experience required
  • Intermediate Excel skills required
  • Advanced knowledge of 3M system or other encoder program required
  • Advanced knowledge of Medical Terminology required
  • Advanced knowledge of professional coding practice standards required

Education:

  • High School Diploma/GED required
  • Current certification in one of the following required: CCS (AHIMA), CCS-P (AHIMA) and/or CPC (AAPC)