Coder Lead, Professional

It's more than a career, it's a calling.

Worker Type:

Job Summary:

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Leads and/or coordinates shift operations, work assignments and daily priorities of assigned activities, resources, and/or associates. Serves as a leader through modeling, mentoring and training assigned staff.
• Manages assigned charge review and coding-related claim work queues to ensure timely and accurate charge capture. Accurately deciphers charge error reasons and plan follow-up steps.
• Reviews medical record documentation in the electronic health record and/or on paper. Identifies, enters and posts CPT-4 and ICD-10 codes to the electronic health record. Identifies need for medical records from outside the organization and follows established procedures to obtain. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Contacts providers and/or support staff when clarification is needed to appropriately bill for services. Ensures all coded services meet appropriate Medicare, National Correct Coding Initiative (NCCI) or payer-specific guidelines.
• Assists coding staff, physician, and other health care practitioners with questions regarding coding and documentation guidelines. Provides ongoing feedback based on observations from coding physician/provider documentation. Assists in educational needs of coding staff based on these conversations and questions.
• Corrects claim edit errors in the work queues, assures charges provide optimal appropriate reimbursement with appropriate documentation. Provides feedback and guidance to coders and clinicians on recurring errors. Suggests rules to proactively work these edits prior to claim edit.
• Partners with follow-up department to analyze payer updates affecting/resulting in coding denials and applies knowledge to assist in correction, submission, and payment of claims. Tracks denials and reports trends to leadership. Provides feedback and guidance to coders and providers when there are recurring issues or new trends.
• Is watchful for charge review, claim edit, and coding-related denial trends and shares trends with supervisor, managers, and team members to facilitate root cause analysis and continuous process improvement. Assists coding teammates with coding questions, charge review, claim edits, payer requirements, and clarification of policies, procedures, and processes where needed.
• Performs other duties as assigned.

EDUCATION

• High School diploma/GED or 10 years of work experience

EXPERIENCE

• Three years' experience

PHYSICAL REQUIREMENTS

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.
• Frequent sitting, standing, walking, reaching and repetitive foot/leg and hand/arm movements.
• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.
• Frequent use of hearing and speech to share information through oral communication. Ability to hear alarms, malfunctioning machinery, etc.
• Frequent keyboard use/data entry.
• Occasional bending, stooping, kneeling, squatting, twisting and gripping.
• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.
• Rare climbing.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 
 
State of Work Location: Illinois, Missouri, Oklahoma, Wisconsin 

•     Certified Coding Associate (CCA) - American Health Information Management Assoc (AHIMA) 
•     Or 
•     Certified Coding Specialist - Physician-based (CCS-P) - American Health Information Management Assoc (AHIMA) 
•     Or 
•     Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) 
•     Or 
•     Certified Professional Coder (CPC®) - American Academy of Professional Coders (AAPC) 
•     Or 
•     Registered Health Information Administrator (RHIA) - American Health Information Management Assoc (AHIMA) 
•     Or 
•     Registered Health Information Technician (RHIT) - American Health Information Management Assoc (AHIMA)

Work Shift:

Department:

Scheduled Weekly Hours:

Benefits:

SSM Health values our exceptional employees by offering a comprehensive benefits package to fit their needs.

• Paid Parental Leave: we offer eligible team members one week of paid parental leave for newborns or newly adopted children (pro-rated based on FTE). 

• Flexible Payment Options: our voluntary benefit offered through DailyPay offers eligible hourly team members instant access to their earned, unpaid base pay (fees may apply) before payday.

• Upfront Tuition Coverage: we provide upfront tuition coverage through FlexPath Funded for eligible team members. 

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SSM Health is an equal opportunity employer. SSM Health does not discriminate on the basis of race, color, religion, national origin, age, disability, sex, sexual orientation, gender identity, pregnancy, veteran status, or any other characteristic protected by applicable law. Click here to learn more.