Lead, Coding Specialist

Interested in a career with both meaning and growth? Whether your abilities are in direct patient care or one of the many other areas of healthcare administration and support, everyone at Parkland works together to fulfill our mission: the health and well-being of individuals and communities entrusted to our care. By joining Parkland, you become part of a diverse healthcare legacy that’s served our community for more than 125 years. Put your skills to work with us, seek opportunities to learn and join a talented team where patient care is more than a job. It’s our passion.

PRIMARY PURPOSE

The primary purpose of the Virtual Lead Coding Specialist is to improve internal and external quality audit scores for coders and the coding department by Conducting ad hoc coding quality reviews to proactively identify coder improvement opportunities, create and facilitate education and training action plans, and collaborate with Coding Integrity Quality and Compliance teams to reduce audit and denial risk to the organization from coding and billing. Demonstrates the ability to provide direction to coding staff as it relates to coding integrity, established coding guidelines and Parkland's policies to ensure accuracy of recorded patient medical information and appropriate reimbursement for services rendered.

MINIMUM SPECIFICATIONS 

Education

- High school diploma required.

- Must have successfully completed an approved coding program;

- OR Must be a graduate of a Health Information Management program.

Experience

- Must have nine (9) years of coding experience in a combination of acute care hospital and clinic professional environment.

Equivalent Education and/or Experience

- May have an equivalent combination of education and/or experience in lieu of specific education and/or experience as stated above.

Certification/Registration/Licensure

- Must be certified through the American Health Information Management Association as one of the following:

- Registered Health Information Management Technician (RHIT)

- Registered Health Information Management Administrator (RHIA)

- Certified Coding Specialist (CCS)

- Certified Coding Specialist

-Physician Based (CCS-P)

Required Tests for Placement

- Must score a minimum of 85% on a pre-employment coding test. Contract coders with a proven coding accuracy rate of 95% at Parkland Health and Hospital System are exempt from this requirement.

Skills or Special Abilities

- Must be able to demonstrate advanced knowledge of ICD-9/ICD-10-CM/PCS coding and abstracting, MS-DRG classification and reimbursement structures, applicable coding edits and general knowledge of Local Coverage.

- Must be able to demonstrate knowledge of reimbursement (Medicare and Medicaid) principles.

- Must have knowledge of medical terminology, the human disease process, anatomy, and physiology.

- Must be able to demonstrate good organizational and leadership skills.

- Must be able to effectively communicate, both orally and in writing.

- Must be able to demonstrate knowledge of computer software applications including MS Office and Computer Assisted Coding (CAC).

Responsibilities

1. Conducts ad hoc coding quality reviews to ensure coding quality of the department.

2. Identifies coder trend opportunities from internal and external audits and advise coding manager of identified trends/patterns and facilitates action plan for improvement.

3. Coaches other coders by training, educating and advising on coding and abstracting according to ICD-10-CM/PCS conventions and guidelines, responding to coding inquiries, reviewing and noting coded charts, providing feedback and monitoring chart corrections to ensure that noted changes have been made to facilitate coding consistency, accuracy, efficiency and appropriate billing and reimbursement.

4. Contributes with workflow, priorities for work completion, and communicating workflow issues to the supervisor. Identifies ways to improve work processes and improve customer satisfaction.

5. Assigns appropriate principle and secondary diagnosis and procedures codes for all episodes of care on inpatient encounters ensuring appropriate DRG assignment according to ICD-10-CM/PCS conventions, guidelines, and hospital policy.

6. Achieve and maintain 95% accuracy on quality reviews and meet assigned productivity standards.

7. Abstracts statistical data from the medical record and enter information according to Parkland's guidelines, policies, and procedures.

8. Demonstrates knowledge of billing and coding requirements for governmental guidelines and private insurance payers. May verify, edit and/or enter charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.

9. Verifies, edits and/or enters charges based on documentation or insurance requirements reporting any discrepancies in a timely manner.

10. Collaborates with physicians and nurses by telephone or in writing to clarify or complete records by obtaining missing diagnoses, procedures, or information, resolving ambiguous coding episodes to ensure that missing information is corrected and resubmitted for payment.

11. Routine Screenings/Proof of Immunizations Exclusions: Virtual workforce employees as defined by Parkland's Virtual Work procedure, and as specified in their job descriptions, are not required to undergo routine screening for communicable diseases including TB, the flu vaccination, or the COVID-19 vaccination.

Job Accountabilities 

1.  Identifies ways to improve work processes and improve customer satisfaction. Makes recommendations to supervisor, implements, and monitors results as appropriate in support of the overall goals of the department and Parkland.
2.  Stays abreast of the latest developments, advancements, and trends in the field by attending seminars/workshops, reading professional journals, actively participating in professional organizations, and/or maintaining certification or licensure. Integrates knowledge gained into current work practices.
3.  Maintains knowledge of applicable rules, regulations, policies, laws and guidelines that impact the area. Develops effective internal controls designed to promote adherence with applicable laws, accreditation agency requirements, and federal, state, and private health plans. Seeks advice and guidance as needed to ensure proper understanding.

Parkland Health and Hospital System prohibits discrimination based on age (40 or over), race, color, religion, sex (including pregnancy), sexual orientation, gender identity, gender expression, genetic information, disability, national origin, marital status, political belief, or veteran status. As part of our commitment to our patients and employees’ wellness, Parkland Health is a tobacco and smoke-free campus.