Performance Monitoring: Track key performance indicators (KPIs), identify performance gaps, and develop improvement strategies to boost team productivity and quality outcomes.
Payment Integrity: Apply strong knowledge of payment integrity principles to identify claim errors, documentation deficiencies, and missed revenue opportunities, ensuring optimal claim accuracy and reimbursement.
Subject Matter Expertise: Act as a coding and auditing expert for surgical specialties, supporting physicians, clinical teams, and business stakeholders in achieving accurate and compliant documentation and coding practices
Lead and manage a team of medical coding specialist ensuring accurate and timely auditing of procedures across various specialties in accordance with industry standards, guidelines and regulatory requirements.
Provide guidance, training, and mentorship to the coding team, fostering a collaborative and high-performing work environment.
Oversee the coding workflow, prioritize work assignments, and ensure productivity and quality targets are met or exceeded.
Stay updated with changes in coding guidelines, payer policies, and industry trends related to surgery coding and payment integrity process and effectively communicate these changes to the team.
Conduct regular audits and quality checks to ensure compliance with coding guidelines, accuracy of coded data, and adherence to documentation requirements.
Collaborate with other departments, such as analytics, repricing, quality, compliance to optimize coding processes and resolve coding-related issues.
Monitor key performance indicators (KPIs) and develop performance improvement initiatives to enhance auditing efficiency, accuracy, and productivity.
Apply payment integrity processes and knowledge to ensure proper coding and billing practices, identify claim and documentation errors and deficiencies, and maximize revenue capture.
Serve as a subject matter expert on multi-specialty surgery coding and payment integrity, providing guidance and support to physicians, clinical staff, and other stakeholders to ensure appropriate documentation, coding, and auditing practices
Bachelor’s degree in Clinical or Healthcare Information Management or a related field. Relevant certifications (e.g. CCS, CPC, CPMA) are mandatory.
Extensive experience in medical coding, with a focus on surgery coding and strong knowledge of CPT, ICD-10-CM, HCPCS coding systems.
Proficient in using coding software and electronic health record (EHR) systems.
Strong analytical and problem-solving skills, with the ability to identify coding-related issues, propose solutions, and implement process improvements.
Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders and build positive relationships.
Detail-oriented with a commitment to accuracy and compliance with coding guidelines and regulations.
Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
Demonstrated knowledge of healthcare industry regulations such as HIPAA and HITECH, and specific knowledge of CMS, Medicare, LCDs, NCDs, Medical Policies, Commercial payer processes and requirements.
