Lead Coder – Risk Management

Job not on LinkedIn

🔥 40 minutes ago

🏈 Alabama, Alaska, +31 more states – Remote

🏈 Alabama – Remote 🐻 Alaska – Remote 🌵 Arizona – Remote 🐊 Florida – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🌶️ New Mexico – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🚗 Michigan – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote ⚔️ Virginia – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $30 - $46 / hour

⏰ Full Time

🟠 Senior

🎲 Risk

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Advocate Aurora Health

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

⚕️ Healthcare Insurance

💰 $10.2M Grant on 2019-08

Healthcare • Healthcare Insurance

Advocate Aurora Health is a leading healthcare organization that operates across various regions including Central Chicagoland, Central Wisconsin, Greater Milwaukee, and more. With a diverse range of career areas such as advanced practice clinicians, behavioral health, nursing, and more, Advocate Aurora Health is committed to helping people live well. The organization offers numerous benefits and opportunities for career advancement, fostering an environment where individuals can thrive and innovate in the healthcare sector. Advocate Aurora Health prioritizes the safety of its candidates and maintains a robust recruitment process to protect sensitive information.

📋 Description

• Acts as a resource and role model to team members, which includes training/orienting, providing day-to-day work direction, and giving input on performance • Assigns, monitors, and reviews progress, quality and accuracy of work, monitors productivity, maintains appropriate staffing levels, directs efforts and provides guidance on more complex issues • Codes routine to complex procedures and diagnoses including hospital-based or surgery center surgical procedures using ICD, CPT, and HCPCS coding guidelines, procedures and protocols for government and commercial payers • Meets or exceeds department quality and production standards • Performs informal quality reviews on a monthly basis providing coding education to coding team members for accuracy • May assist with provider education/orientation regarding policy requirements of federal and state government agencies • Abstracts documentation to choose correct ICD, CPT, HCPCS codes according to standard coding guidelines, procedures and protocols • Detects, reports and acts as a resource to assist in resolving billing compliance issues • Serves as liaison between business office, medical records, patient care and/or coding department by providing feedback to caregivers and leaders • Responsible for processing denial management claims and addressing patient concerns • Serves as a resource to caregivers regarding pre-authorizations, referrals, and estimating charges prior to a patient's visit • Coordinates payer audit reviews and acts as a resource for coding-related audits • Participates in various department projects including but not limited to researching new services, claim scrubbing, quality checks/assessing errors, presenting demonstrations, etc. • Acts as the system/application administrator; ensures the integrity of the system and recognizes performance issues • Performs calibration and troubleshooting procedures and escalates unresolved issues as needed • Suggests modifications to current policies and procedures that are needed to coincide with requirements of insurance payers • Serves as subject matter expert in your assigned specialty and actively participate in the Coding meetings as a problem solver • Adhere to organizational and internal department policies and procedures to ensure efficient work processes • Expertise in query guidelines, and coding standards • Follow up and obtain clarification of inaccurate documentation as appropriate • Reviews complex medical documentation at a highly skilled and proficient level from clinicians, qualified health professionals and hospitals in order to assign diagnosis and procedure codes utilizing ICD-10 CM/PCS, CPT, and HCPCS • Assigns and ensures correct code selection following Official Coding Guidelines and compliance with federal and insurance regulations utilizing an EMR and/or Computer Assisted Coding software • Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines • Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement • Maintains the confidentiality of patient records • Reports any perceived non -compliant practices to the coding leader or compliance officer • Achieves productivity expectations to support discharged not final billed (DNFB) • Assist in the production of annual edit review based on CPT, ICD and HCPCS changes as well as assist in development of edits based on publications and society updates

🎯 Requirements

• Certification required: Coding Certification issued by one of the following certifying bodies: American Academy of Coders (AAPC), or American Health Information Management Association (AHIMA) • Advanced training beyond High School that includes the completion of an accredited or approved program in Medical Coding Specialist (or equivalent experience) • Typically requires 7 years of experience in professional coding that includes experiences in revenue cycle processes and health information workflows or related health care leadership experience • Knowledgeable in researching coding related topics and issues • Advanced proficiency of ICD, CPT and HCPCS coding guidelines • Advanced knowledge of medical terminology, anatomy and physiology • Excellent computer skills including the use of Microsoft office products, electronic mail, including exposure or experience with electronic coding systems or applications

🏖️ Benefits

• Paid Time Off programs • Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability • Flexible Spending Accounts for eligible health care and dependent care expenses • Family benefits such as adoption assistance and paid parental leave • Defined contribution retirement plans with employer match and other financial wellness programs • Educational Assistance Program