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Lead Coder

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full-time

Posted on:

Location Type: Remote

Location: Texas • United States

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Job Level

Senior

About the role

  • In compliance with established guidelines, reviews supporting documentation to ensure accurate coding assignments (ICD, CPT, HCPCS) in support of third party payer, NCCI guidelines and THR/THPG policies.
  • Maintains documentation to record/track discrepancies for applicable provider specialties.
  • Monitor and assist charge capture and/or denial coding staff as needed.
  • Monitor CRD charge capture/denial WQs and assist in resolving system issues preventing charges from clearing the WQs (e.g. misrouting, charges not dropping, edits not functioning as expected).
  • Monitor coding discrepancy logs to identify trends impacting coding.
  • Performs root cause analysis and creates action plans for issues impacting coding quality or established KPI metrics.
  • Participates in special projects and completes other duties as assigned.
  • Serves as a subject matter expert, providing direction to less experienced staff.
  • May assist with training, auditing, and/or reviewing productivity and quality rates under the leadership of department management.
  • Respond to requests for assistance from inter-departmental teams, external vendors, providers and operations as well as addressing escalated questions pertaining to coding and quality distribution lists.
  • Process requests to force override system held charges, charge corrections, void charges, merge charges, deferred charges and write offs.
  • Support designated meetings when required by department management (e.g., Optimization, Edits, Lab, Denial, Payor Escalations, CRD Policy & Procedures, etc.) by preparing documentation, communicating updates, minutes, following action items and/or serving as proxy.

Requirements

  • H.S. Diploma or Equivalent REQUIRED
  • Bachelor's Degree Related field
  • 4 Years Coding, denials, and/or AR experience in lieu of degree REQUIRED
  • 5 Years Coding and/or Denials experience REQUIRED
  • CPC - Certified Professional Coder Upon Hire REQUIRED or CCS-P - Certified Coding Specialist - Physician-based Upon Hire REQUIRED
  • Other Specialty certification such as CGSC, COSC, CCC, CPB, CPPM, CHONC, CFPC, CPMA, etc. Upon Hire preferred
  • Extensive understanding of health insurance and medical coding requirements.
  • Extensive knowledge of third party billing regulations, professional operations, and third party payer requirements.
  • Must possess strong written & verbal communication skills, good interpersonal skills.
  • Must be detail oriented and have strong organizational skills.
  • Must possess a strong work ethic and a high level of professionalism.
  • Must have advanced computer skills (e.g., Excel, Power Point, Word, Outlook, OneNote, SharePoint)
  • Must possess strong analytical, research & reporting skills
  • Must be comfortable leading people/demonstrating leadership qualities in alignment with THPG promise behaviors
Benefits
  • 401k
  • PTO
  • medical
  • dental
  • Paid Parental Leave
  • flex spending
  • tuition reimbursement
  • Student Loan Repayment Program
Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills & Tools
ICD codingCPT codingHCPCS codingcoding quality analysisroot cause analysischarge capturedenial codingKPI metricscoding auditsdiscrepancy tracking
Soft Skills
communication skillsinterpersonal skillsorganizational skillsdetail orientedstrong work ethicprofessionalismleadership qualitiesanalytical skillsresearch skillsreporting skills
Certifications
CPCCCS-PCGSCCOSCCCCCPBCPPMCHONCCFPCCPMA