Sr. Medical Coder

Job Code: SRMC - 114
Revision Date: August 10, 2023

Starting Salary: $21.52 hourly; $44,768 annually
FLSA: Exempt

Overview

We are an agency committed to innovative behavioral health services in trauma-informed care that promote healing and recovery to instill a sense of empowerment and foster a lifelong sense of resilience.

General Description

The purpose of this position is to supervise assigned Billing and Coding Specialists. This position is responsible for ensuring the interpretation of clinical documentation completed by the health care providers for the health record(s) and for quality assurance are in alignment with clinical documentation and billing guidelines. Medical Coding Lead serves as an expert resource regarding all aspects of coding and charge capture by guiding and directing specialists in their day-to-day job functions.

This class works under close to general supervision according to set procedures but determines how or when to complete tasks. This class will report directly to the Chief of Revenue Cycle.

Duties and Responsibilities

The functions listed below are those that represent the majority of the time spent working in this position. Management may assign additional functions related to the type of work required for this position as necessary.

• Supervises, directs, and evaluates assigned staff, processing employee concerns and problems, directing work, counseling, disciplining, and completing employee performance appraisals.
• Coordinates, assigns and reviews work and establishes work schedules; maintains standards; monitors status of work in progress; inspects completed work assignments; answers questions; gives advice and direction as needed.
• Trains new and existing team members. Investigates and resolves issues pertaining to coding and charge capture.
• Collaborates with medical staff and quality management team to correctly align diagnosis documentation and billing coding to improve the quality of clinical documentation and correctness of billing codes prior to claim submission to third party payers.
• Identify opportunities for improvement of clinical documentation and accurate payment classification or ICD-10 assignments on the health records.
• Provides guidance and expertise in the interpretation of, and adherence to, the rules and regulations for documentation for new and/or existing ICD-10 codes.
• Provides coding and guidance for non-standard billing.
• Assist with maintaining system wide consistency in coding practices and ethical coding compliance.
• Performs on going Internal audits with Coding Team to ensure that clinical coding and documentation are accurate for proper reimbursement and coding compliance is completed.
• Performs Internal audits to ensure the principal diagnosis, principal procedure, complications and co morbid conditions, other diagnoses, and significant procedures are coded accurately on the claims.
• Monitors coding work and trends, then provides education where opportunities are identified and needed.
• Demonstrates extensive knowledge of clinical documentation and its impact on reimbursement under Medicare Severity Adjustment System (MS-DRG), and Ambulatory payment classification (APC) or utilized operation systems.
• Acts as a knowledge resource to ancillary clinical departments and reimbursement team regarding charge related issues, processes and programming.
• Assists with education and training of Coding team or other staff involved in learning coding.
• Assists and participates with special projects through meetings/committees in order to properly educate physicians, nursing, coders, clinic staff, with proper and accurate documentation for positive outcomes.
• Maintains a current knowledge in all coding regulatory updates, and in all software used for coding and health information management.
• Tracks and creates monthly reports identifying coding and Health Risk Adjusted Factors identifies area of improvement and opportunities for education of staff.
• Provides strategic guidance and direction for system-wide coding services or non-standard billing, create and manage a strong coding culture, ensures the recruitment, training, and retention of motivated competent coding managers, coding specialists, and coding auditors; establishes goals and standards for performance appraisals.
• Tracks numerous metrics related to the patient engagement cycle including record coding error rates and billing turnaround times to develop sound revenue cycle analysis and reporting.
• Analyzes the top coding denials per payor and identifies solutions to increase cash.
• Maintains a supportive and positive working relationship with medical staff and senior level management; serves as an internal consultant throughout the organization on coding related issues including MS-DRG/ APC reimbursement methodologies, physician documentation, and coding quality.
• Develop and maintain system-wide coding guidelines and documentation requirements and monitor compliance; develop and implement training and educational programs for physicians, medical/mental health professionals and coding specialists to ensure consistency of quality data.
• Promotes individual professional growth and development by meeting requirements for mandatory/continuing education and skills competency; supports department-based goals which contribute to the success of the organization; serves as preceptor, mentor, and resource to less experienced staff.
• Assist with Electronic Health Record set up to include new or existing development.
• Assists with the development of Value Base Models as needed.
• Performs other duties as assigned.

Minimum Education and Experience Requirements

Requires Associate's degree in Business Administration or health care related field supplemented by two (2) years of health plan (or similar) experience in utilization management and/or case management, billing and processing payments and one (1) year of supervisory experience; or possession of any equivalent combination of education, training, and experience which provides the requisite knowledge, skills, and abilities.

Required Knowledge and Abilities

Knowledge of trauma-informed theories, principles, and practices (includes multi-faceted understanding of concepts such as community trauma, intergenerational and historical trauma, parallel processes, and universal precautions), preferred.

Physical Demands

Performs sedentary work that involves walking or standing some of the time and involves exerting up to 10 pounds of force on a regular and recurring basis or sustained keyboard operations.

Unavoidable Hazards (Work Environment)

• Involves routine and frequent exposure to:
  • Bright/dim light; Dusts and pollen.
  • Other extreme hazards not listed above.

Special Certifications and Licenses

• Must have any one of the following coding certifications at time of hire: Certified Coding Specialist (CCS), Certified Professional Coder (CPC), or Certified Coding Specialist - Physician-Based (CCS-P).

Americans with Disabilities Act Compliance (ADA)

Emergence Health Network is an Equal Opportunity Employer. ADA requires Emergence Health Network to provide reasonable accommodations to qualified persons with disabilities. Prospective and current employees are encouraged to discuss ADA accommodations with management.

Other Job Characteristics

• Staffing requirements, including criteria that staff have diverse disciplinary backgrounds, have necessary State required license and accreditation, and are culturally and linguistically trained to serve the needs of the clinic's patient population.
• Credentialed, certified, and licensed professionals with adequate training in person-centered, family centered, trauma informed, culturally-competent and recovery-oriented care.

Note: This Class Description does not constitute an employment agreement between the Emergence Health Network and an employee and is subject to change by the Emergence Health Network as its needs change.