Coder Lead - Risk Management

Department:13497 Enterprise Revenue Cycle - Coding Production Operations: Professional Coding Operations Medical and PrimaryStatus:Full time

Benefits

Eligible:YesHours Per Week:40Schedule Details/Additional Information:Will support: Risk Management (HCC Coding)Schedule: Monday - Friday 1st shift 40 hours a week.Certification required: Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA).Certification Desired:American Academy of Coders (AAPC) CRC certificationRemote opportunity:Advocate Health may approve those who wish to work out of the following registered states: AL, AK, AR, AZ, DE, FL, GA, IA, ID, IL, IN, LA, KS, KY, ME, MI, MO, MS, MT, NC, ND, NE, NH, NM, NV, OH, OK, PA, SC, SD, TN, TX, UT, VA, WI, WV, WYPay Range:$30.70 - $46.05Major Responsibilities:Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance. Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues.Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers. Meets or exceeds department quality and production standards.Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy.

May assist with provider education/orientation regarding policy

Requirements

of federal and state government agencies.Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols. Detects, reports and acts as a resource to assist in resolving billing compliance issues. Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders.Responsible for processing denial management claims and addressing patient concerns.

Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit. Coordinates payer audit reviews and acts as a resource for coding-related audits.Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. Acts as the system/application administrator; ensures the integrity of the system and recognizes performance issues.

Performs calibration and troubleshooting procedures and escalates unresolved issues as needed.Suggests modifications to current policies and procedures that are needed to coincide with

Requirements

of insurance payers. Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver. Adhere to organizational and internal department policies and procedures to ensure efficient work processes.

Expertise in query guidelines, and coding standards. Follow up and obtain clarification of inaccurate documentation as appropriate.Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS. Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software.Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines.

Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement. Maintains the confidentiality of patient records. Reports any perceived non-compliant practices to the coding leader or compliance officer.Meets and exceeds departmental quality (95% or more) and productivity standards (100%).

Achieves productivity expectations to support discharged not final billed (DNFB). Assist in the production of annual edit review based on CPT, ICD and HCPCS changes as well as assist in development of edits based on publications and society updates.Performs any other assigned duties since the duties listed are general in nature and are examples of the duties and responsibilities performed and are not meant to be construed as exclusive or all-inclusive. Management retains the right to add or change duties at any time.

Answer and prioritize correspondence at all levels e.g., coding assistants, coders, leads, supervisors, and managers.Licensure, Registration, and/or Certification Required:Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA)Education Required:Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience)Experience Required:Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience. Knowledge, Skills & Abilities Required:Maintain continuing education by attending webinars, reviewing updated CPT assistant guidelines and updated coding clinics. Knowledgeable in researching coding related topics and issues.Advanced profiency of ICD, CPT and HCPCS coding guidelines.

Advanced knowledge of medical terminology, anatomy and physiology.Excellent computer skills including the use of Microsoft officeproducts, electronic mail, including exposure or experience with electronic coding systems or applications.Excellent communication (oral and written) and interpersonal skills.Excellent organization, prioritization, and reading comprehension skills.Excellent analytical skills, with a high attention to detail. Ability to work independently and exercise independent judgment and decision making.Ability to meet deadlines while working in a fast-paced environment.Ability to take initiative and work collaboratively with others.Physical

Requirements

and Working Conditions:Exposed to a normal office environment.Must be able to sit for extended periods of time.Must be able tocontinuously concentrate.Position may be required to travel to other sites; therefore, may be exposed to road and weather hazards.Operates all equipment necessary to perform the job.This job description indicates the general nature and level of work expected of the incumbent. It is not designedto cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.This job description indicates the general nature and level of work expected of the incumbent.

It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.#REMOTTEOur Commitment to You:Advocate Health offers a comprehensive suite of Total Rewards:

Benefits

and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more - so you can live fully at and away from work, including:CompensationBase compensation listed within the listed pay range based on factors such as

Qualifications

, skills, relevant experience, and/or trainingPremium pay such as shift, on call, and more based on a teammate's jobIncentive pay for select positionsOpportunity for annual increases based on performance

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and morePaid Time Off programsHealth and welfare

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such as medical, dental, vision, life, and Short- and Long-Term DisabilityFlexible Spending Accounts for eligible health care and dependent care expensesFamily

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such as adoption assistance and paid parental leaveDefined contribution retirement plans with employer match and other financial wellness programsEducational Assistance ProgramNote: Eligibility for programs listed above may depend on your FTE or status (e.g., full-time, part-time, per diem, temporary, etc.); please ask a Recruiter for more information during an interview.About Advocate Health Advocate Health is the third-largest nonprofit, integrated health system in the United States, created from the combination of Advocate Aurora Health and Atrium Health. Providing care under the names Advocate Health Care in Illinois; Atrium Health in the Carolinas, Georgia and Alabama; and Aurora Health Care in Wisconsin, Advocate Health is a national leader in clinical innovation, health outcomes, consumer experience and value-based care. Headquartered in Charlotte, North Carolina, Advocate Health services nearly 6 million patients and is engaged in hundreds of clinical trials and research studies, with Wake Forest University School of Medicine serving as the academic core of the enterprise.

It is nationally recognized for its expertise in cardiology, neurosciences, oncology, pediatrics and rehabilitation, as well as organ transplants, burn treatments and specialized musculoskeletal programs. Advocate Health employs 155,000 teammates across 69 hospitals and over 1,000 care locations, and offers one of the nation’s largest graduate medical education programs with over 2,000 residents and fellows across more than 200 programs. Committed to providing equitable care for all, Advocate Health provides more than $6 billion in annual community

Benefits

.Originally posted on Himalayas