Lead Coder-Professional Services WMCG

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Work Shift

Various (United States of America)

Job Summary

The Lead Coder-Professional Services assists in the day-to-day operation of the department, in addition to performing

front line coding for either the Non-Surgical or Surgical Coding section within the Professional Services Coding and

Compliance Department. This includes coordinating schedules and distributing work for up to 26 professional coders

who work on site and remotely. This position serves as a resource for front line coders specifically related to operations

issues, including being a superuser for coding applications.

Core Responsibilities and Essential Functions

Develops and maintains a detailed understanding of the complete billing process to include both the

technical and professional component. Maintains working knowledge of GE Healthcare (IDX), Healthquest,

and Cerner Powerchart. Assists the Coding Education Specialist with conducting quality audits of coded

services by the coding staff. Ensures staff is coding properly and maintaining industry standard productivity.

Assists with developing and maintaining departmental policies and procedures.

Assists in training all incoming coding staff as well as assists staff with coding questions when guidance is

needed. Provides monthly feedback to Coding Education Specialist regarding coding staff accuracy,

productivity, and coding/educational needs. Manages and maintains coding review backlog and work files

to within 3 days of documentation completion. Assists in the review and analysis of the documentation and

coding patterns of providers.

Updates billing forms timely with all current code sets for CPT, HCPCS, and ICD-10. Maintains current billing

requirements of all carriers to determine when a service is billable and how it should be billed appropriately

for maximum reimbursement. Maintains a close working relationship with the Revenue Cycle Management

Team. Assists with identifying billing concerns that must be corrected and reported to the AU Medical

Associates Compliance Office.

Analyzes available monthly denial reports. On a monthly basis, trends performance of the various billing

areas and presents results to Coding Education Specialist. Assists Coding Education Specialist with providing

denial trends to Physicians. Maintains industry standard compliant coding and billing knowledge to include

federal and state regulations. Assists the Coding Education Specialist with disseminating information to

staff.

Performs other duties as assigned

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education

• High School Diploma General or GED General or Bachelors Health Information Management-Preferred

Required Minimum License(s) and Certification(s)

All certifications are required upon hire unless otherwise stated.

• CPC - Cert Prof Coder or CCS - Cert Coding Spec or RHIA - Reg Health Information Admin or RHIT - Reg Health Information Tech

Additional License(s) and Certification(s)

CPB and CPMA through AAPC within 1 Year Preferred

Required Minimum Experience

Minimum 4 years Interventional and Surgical procedures related experience. Required and

Required Minimum Skills

Previous third-party reimbursement experience High

Proven experience with coding and medical terminology High

Knowledge of state and federal laws pertaining to the billing and collection of patient accounts High

Must have ability to handle multiple projects, meet deadlines, and assign priorities High

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