Summary:

The lead coding specialist reports to the Manager of Hospital Coding for Lifespan Corporate Services. Under general supervision and within Hospital and departmental policy the lead inpatient coder reviews inpatient clinical documentation to extract data and assign appropriate codes in accordance with the inpatient ICD-10 CM/PCS and CPT Official Guidelines for Coding and Reporting of various inpatient scenarios covering complex disciplinary service lines throughout all Lifespan affiliates. Determines appropriate code assignment for optimal classification and accurate and compliant clinical data reporting standards. Performs onboard training of new hire staff review daily work processes and perform periodic coding denial reviews.

Responsibilities:

Reviews inpatient medical records covering complex disciplinary service lines to accurately identify all treated diagnoses and procedures performed reporting the correct ICD-10 CM/PCS code(s) in accordance with official coding guidelines. Enters all coded/abstracted information utilizing the 3M 360 Encompass system to ensure accurate MS-DRG or APR-DRG assignment. Ensures the medical record documentation supports the codes selected for the principal diagnosis secondary diagnoses complications co-morbid conditions procedures and discharge disposition. Works collaboratively with the Clinical Documentation Integrity team. Understands clinical documentation to recognize when a query to the physician is required. Identifies and recommends physician queries when documentation in chart is incomplete ambiguous or unclear. Maintains coding accuracy and productivity standards. Acts as a resource to coding staff on official coding principals and guidelines. Works collaboratively with denial management teams to correct coding related denials including medical necessity and modifier usage. Perform peer-to peer training and answer routine daily questions. Problem solving consisting of identifying and resolving problems in a timely manner and/or developing alternative solutions. Serves as preceptor and mentor with new staff providing oversight and resources when needed. Ability to recognize and understand clinical documentation pertinent for coding. Good writing skills to prepare compliant physician queries. Actively participates in team meetings to enhance functional excellence. Good writing skills to prepare compliant physician queries. Abides by the *Standards of Ethical Coding* as set forth by the American Health Information Management Association.

Other information:

EDUCATION:

Associate degree in health information technology (AHIMA (preferred) [RHIA RHIT] and/or successful completion of coding certification program. Coding certification required from the American Health Information Management Association CCS/ CCA. Maintenance of coding professional credentials/competencies required through internal and external educational opportunities.

Ability to recognize and understand clinical documentation criteria pertinent for coding including clinical indicators risk factors and treatments for diagnoses.

Trained in medical terminology medical science disease processes anatomy and physiology.

Computer literate: capable of researching websites to access regulatory requirements.

Ability to navigate the patient electronic medical record.

Strong writing organizational and communication skills required.

EXPERIENCE:

Minimum 3 years of experience coding inpatient medical records. Working knowledge of EMR system knowledge of MS-DRG and APR-DRG reimbursement systems ICD-10 CM/PCS CPT and HCPCS guidelines.

WORKING CONDITIONS:

Requires long periods of sitting to review medical records.Ability to work under stressful conditions to maintain accounts receivable days achieving productivity and accuracy.

Remote / home office environnent.

All staff working remotely must adhere by the Flexible Work Arrangements Policy and follow the Flexible Work Arrangements Guidelines and Forms instructions.

INDEPENDENT ACTION:

Performs independently within the department*s policies and practices.Refers specific complex problems to the supervisor when clarification of the departmental policies and procedures are required.

SUPERVISORY RESPONSIBILITY:

None

Lifespan is an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race color religion sex national origin age ethnicity sexual orientation ancestry genetics gender identity or expression disability protected veteran or marital status. Lifespan is a VEVRAA Federal Contractor.

Location: Corporate Headquarters USA:RI:Providence

Work Type: Full Time

Shift: Shift 4

Union: Non-Union