Clinical Lead Coding Specialist II - Full-time / Part-time

POSITION SUMMARY:The Clinical Lead Coding Specialist II performs internal quality assessment reviews on HIM Outpatient Coders who code Diagnostics, Surgical, & Observation record to ensure compliance with national coding guidelines and BRRH coding policies for complete, accurate, and consistent coding that result in appropriate reimbursement and data integrity. The lead will work with the team to improve the accuracy, integrity, and quality of patient data, to ensure minimal variation in coding practices and improve the quality of physician documentation within the body of the medical record to support code assignments. The lead will also provide coder specific education and global coding education based on review findings and trends. Additionally, on an as need basis, the lead will be responsible for coding outpatient medical records according to ICD-10-CM and CPT coding guidelines. The lead will review medical record documentation for outpatient encounters, assigning appropriate diagnostic and procedural codes and modifiers; and capture of quality management and statistical data elements for organizational reporting. Codes are assigned to each diagnosis and procedure documented in the medical record by the physician. Codes are entered into the hospital's encoder and assigned to the optimal payment grouping. Patient information is abstracted from the medical record to provide a health information database.POSITION REQUIREMENTS:Minimum Education and/or Experience:* Graduate of an accredited school of Health Information Management with Certification as a Registered Health Information Technician (RHIT), Registered Health Information Administrator (RHIA), OR certification as a Certified Coding Specialist (CCS). Prior clinical outpatient coding experience through an accredited educational program or verifiable work experience. Has a minimal knowledge/experience with hospital information systems application and Microsoft WINDOWS.* Minimum of 2 – 3 years of outpatient coding experience.Licensure/Regulation/Certification:* Registered Health Information Management (RHIT) certification* Registered Health Information Administrator (RHIA) certification* Certified Coding Specialist (CCS) certification preferredPOSITION EXPECTATIONS & RESPONSIBILITIES:* Leads, coordinates and performs all functions of quality reviews (routine, policy driven and incentive plan driven) for outpatient coding across the organization.* Assists the Coding Manager in the review and improvement of processes and services.* Coordinates coder training and orientation win conjunction with Coding Manager.* Reports to the Coding Manager periodically on team and individual work accomplishments, problems, progress in mastering tasks and work processes, and individual and team training needs.* Coach, facilitate, solve work problems, and participate in the work of the team.* Assists in ensuring coding staff adherence with coding guidelines and policy.* Assists in ensuring coding compliance and reports status to the Coding Manager and HIM Director.* Assures accounts that cannot be coded are held for valid reasons and documented accurately utilizing 3M HDM/HPF unbilled reason codes.* Provides back up for coders.* Expected to lead individuals and groups toward desired outcomes, setting high performance standards and delivering quality services.* Abstract and enter coded data and designated quality management and statistical for hospital reporting requirements. Coder holds and routes medical records concurrently for various designated studies reviews/studies.* Review and respond to identified encoder APC/ASC and other Payer edits during the data abstraction process prior to completion of coding and billing. Assists in the resolution of identified APC and other payer edit issues upon notification by administrative entities.* Review outpatient encounters (Emergency Department , Outpatient Testing, Observation Services, Outpatient Surgery Center, and therapeutic encounters requiring minimal Procedural system coding) and associated information (i.e., scripts & diagnoses) for the determination and accurate assignment of all appropriate documented diagnoses, procedures, and modifiers, utilizing ICD-10-CM, CPT-4 and any other designated coding nomenclature systems. Assign codes in accordance with AHA official coding guidelines, CMS regulations and hospital policy.* Makes appropriate corrections to the claims requiring ICD-10-CM procedure or diagnoses code changes.* Assign and sequence codes based on medical record document in accordance with the official coding guidelines of the Cooperating Parties and any other official CMS and Local Medical Review Policy guidelines and definitions.* Participates in quality reviews for performance improvement.* Incumbent may be required to perform emergency duty before, during and/or beyond normal work hours or days in the event of an emergency, crisis situation or disaster (man-made or natural) including evacuation sites.* The person in this position will work in a smoke-free location and is expected to adhere to all smoking restrictions.* In the spirit of wellness for both our employees and patients, Boca Raton Regional Hospital has instituted a mandatory influenza prevention vaccination program. Current employees must receive the influenza prevention vaccination free of charge during the recognized flu season. As a condition of employment, new hires will be required to comply with all program rules. This is a mandatory program with the exception of documented medical or religious reasons for not receiving the vaccine. For further information on this progressive program, please contact Boca Raton Regional Hospital's Human Resources Department at 561-955-4075.