Physician Coder Lead - MWV/TCM/CCM

Department: 10271 Enterprise Revenue Cycle - Professional Production Coding Specialty Status: Full time Benefits Eligible: Yes Hours Per Week: 40 Schedule Details/Additional Information: Hours are M-F (some early mornings required, flexible schedule). Supports MWV / Medicare Wellness Visits, TCM /Transitional Care Management and /CCM Chronic Care Management. This is a Remote Opportunity Pay Range $30.15 - $45.25 Major 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 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. 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. #REMOTE #LI-REMOTE Our 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: Compensation Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training Premium pay such as shift, on call, and more based on a teammate's job Incentive pay for select positions Opportunity for annual increases based on performance Benefits and more Paid Time Off programs Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability Flexible Spending Accounts for eligible health care and dependent care expenses Family benefits such as adoption assistance and paid parental leave Defined contribution retirement plans with employer match and other financial wellness programs Educational Assistance Program 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. This is Transformation One shared purpose brought us together. Now, as one of the 10 largest not-for-profit, integrated health systems in the United States, our combined strength and stability drives us forward. Starting with You Caring for nearly 3 million people has inspired a transformation. One in which the patient’s experience guides our vision and empowers us to offer new possibilities in our communities. Reshaping Access What is access? It’s offering more sites of care than any other health system in the Midwest. But there’s a new frontier. Access is exploring the latest technologies to deliver care to patients exactly where they are and exactly when they need it Inspiring Professionals With our dynamically inclusive workforce and strong connections to the places where we live and work, we’ll touch more lives and contribute to stronger and more vibrant communities. Transforming Care We’re redefining the standard for care with world-class doctors and caregivers, innovative solutions, outstanding outcomes, and leading-edge research and clinical trials. Combined, Advocate and Aurora are recognized for clinical excellence in: Cardiovascular Care Neurosciences Gynecology Oncology Pediatrics Primary Care Neurology Geriatrics Trauma Care

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