PACE Medical Coding Lead (Hybrid)

Position Summary:

The PACE Medical Coding Lead will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting. While reporting to the PACE Coding Manager, will work collaboratively to perform coding training, audits, research, and assist with special projects.

This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to work on-site at least once per month; additional on-site presence may be required based on business need

Essential Functions of the Job:

• Performs coding training, coding audits, provider audits, research, scheduling, and special projects assigned by the PACE Coding Manager
• Responsible for monitoring coding work queues, including deployment of coders to areas of greatest need
• Assist with education in-services for physicians, other providers and clinical staff relating to documentation, coding and charging guidelines
• Perform research, run various reporting and assist with general coding as needed and as requested
• Monitor coding operations with respect to workflows and regular reporting: evaluate workflows for maximum efficiencies and problem solve work queue issues when accounts/charges are not flowing properly, making recommendations as necessary
• Maintain updated documentation of all workflows
• Codes complicated medical charts exceeding 50 diagnoses
• Determines all HCC codes associated with patient encounters
• Keeps up to date with the latest CMS risk adjustment guidelines
• Reviews Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers
• Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications
• Communicates effectively with providers concerning documentation to assure proper coding and reimbursement
• Identifies all chargeable items within each progress note to ensure proper CPT/HCPCS codes for each of the items
• Applies sequencing guidelines for the diagnosis codes and selection of the principal diagnosis and procedure according to ICD-10 guidelines
• Tracks open/close encounter reports to assure that all patients seen in the clinic are properly coded
• Organizes & prioritizes all work to ensure that records are coded in time frames that will be in line with department policies
• Maintains knowledge of Anatomy & Physiology to interpret general medical classifications for coding including the most complicated encounters/cases
• Acts as an expert resource person to other coders & personnel in other departments regarding coding questions & issues
• Participates in ongoing education, including in-service training and other activities to maintain and improve competence
• Adheres to SYHC's Core Competencies and professional Code of Conduct Behavior Standards in their day-to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment

Additional Duties and Responsibilities:

• Adheres to all applicable SYHC's Policies, Procedures and processes
• Demonstrates skills in collaboration with team and problem-solving
• Excellent written and oral communication skills
• Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops
• Attends meetings as required and participates on committees as directed
• Demonstrates courtesy and treats every patient and employee with dignity in every interaction
• Assists in the maintenance and/or revision of established Departmental Policies and Procedures
• Maintains confidentiality of all patient electronic medical records
• Maintains a clean, safe, and organized work area at all times
• Performs all other related duties as assigned or requested

Job Requirements

Experience Required:

• One (1) year of medical coding experience required with a CPC, CRC, or CCS

Education Required:

• High School Diploma or GED Equivalent

Certifications Required:

• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional Medical Auditor (CPMA), or Certified Professional Compliance Officer (CPCO) from the American Academy of Professional Coders (AAPC)
• Or, Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA)

Verbal and Written Skills Required to Perform the Job:

• Good written and verbal communication
• Strong communication and presentation skills
• Comfortable speaking with people at an executive level or physician level

Technical Knowledge and Skills Required to Perform the Job:

• Superb organizational ability and exceptionally analytical
• Experience and knowledge with Microsoft Office software

Equipment Used:

• Company’s Laptop, occasionally personal phone

Working Conditions and Physical Requirements:

• This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to work on-site at least once per month; additional on-site presence may be required based on business need
• Long Irregular hours; may work weekends
• Prolonged periods of sitting, and constant walking and standing
• Driving and occasional travel required

Universal Requirements:

Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.