What are the responsibilities and job description for the Clinical Quality Coder Lead - Hospital Based position at Aurora Health Care?
Major Responsibilities
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- Ensure compliance with regulatory coding standards, including CMS, QIOs, NCCI edits, and payer-specific requirements, while adhering to AHIMA’s Standards of Ethical Coding.
- Review clinical documentation and diagnostic results in the EHR to assign accurate ICD-10-CM/PCS and CPT/HCPCS codes that support organizational and Clinician Services initiatives.
- Query providers when documentation is unclear, following established policies to ensure coding accuracy and completeness.
- Collaborate with cross-functional teams—including Coding, CDI, CMD, and Quality—to advance documentation improvement practices and align with enterprise goals.
- Participate in special projects that support documentation, compliance, and operational excellence.
- Promote a professional, team-oriented service culture, modeling collaboration and accountability across Clinician Services and partner departments.
- Identify improvement opportunities through analysis and review, partnering with leadership and team members to implement enhancements.
- Demonstrate technical proficiency in using EHR systems, coding software, and official coding resources to support accurate and efficient documentation.
- Maintain confidentiality of patient records, and report any non-compliant practices to Documentation and Risk leadership or compliance officers.
- Engage in continuous learning, staying current with evolving coding guidelines, terminology, and best practices through training, publications, and credential maintenance
- Prior clinical experience as a licensed and/or certified qualified healthcare practitioner in location/area of practice.
- MD or APP or RN or must have CRCR/CMD certification within 12 months of hire.
- RHIA or HIT or CCS or CCS-P or CPC;
- Specialty credential required within one year of employment.
- Completion of advanced training in revenue cycle management through a recognized or accredited program, equivalent in scope and rigor to post-secondary education. High school diploma or GED required.
- 5 years of experience in expert-level professional and/or facility coding, and experience in collaborating with other teams within an organization, and/or educating/training licensed clinicians. Advanced level of ICD-10- CM/PCS and/or ICD-10-CM/CPT/HCPS for a large complex health care system or medical group.
- Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage determinants, research-related restrictions, ICD-10 CM/PCS, and CPT/HCPCS coding classifications.
- Demonstrated proficiency in Microsoft Office Suite (Word, Excel, PowerPoint, Teams, etc.) or similar products and in patient accounting and billing systems.
- Ability to deal and work effectively with multiple departments and in matrix organizational structures. Proven ability to influence others not directly reporting to them. Strong oral and written communication skills.
- Strong understanding of medical terminology, anatomy, and physiology to support precise code assignment.
- Highly proficient in problem-solving and strong attention to detail.
- Advanced knowledge of Epic.
- Follow organizational and divisional remote work policy and guidelines.
- Operates all equipment necessary to perform the job.
- Handles a fast paced and creative work environment moving independently from one task to another.
- Makes sound decisions within limited time frames and always conducts business in a professional manner and has demonstrates ability to work cooperatively and effectively with others on an individual and team basis.
- This position may require travel, therefore, will be exposed to weather and road conditions.
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Salary : $40 - $60