Lead Professional Coder
Rogers Behavioral Health
Summary
The Lead Professional Coder is responsible for day-to-day operations of the Coding Unit, auditing, coordinating, and ensuring optimal coding is associated with medical records, data integrity, and quality of documentation in accordance with Rogers Medical Staff by-laws, Joint Commission, Federal and State regulations. Acts as a liaison between clinical and administrative teams.
Job description
Job Duties & Responsibilities
- Serves as the key point of contact for coding information and provides feedback and problem resolution.
- Coordinates communication and process information between coding, providers, and administration.
- Provides onsite coding and documentation education and feedback to providers for coding changes (CPT including E&M, modifiers and internal codes, ICD-9, ICD-10, HCPCS), annual updates, payer requirements and insurance rejection resolution.
- Coordinates responses to provider questions along with Compliance and Clinical Informatics team members.
- Applies appropriate diagnostic and procedural codes to patient health records for document retrieval, analysis and claim processing.
- Abstracts pertinent information from patient records.
- Assigns ICD, CPT or HCPCS codes, creating APC or DRG assignments.
- Queries physicians when code assignments are not straightforward or documentation is inadequate, ambiguous, or unclear.
- Reviews medical records concurrently prior to claim submission.
- Keeps abreast of and complies with coding guidelines and reimbursement reporting requirements.
- Coordinates with Manager and Director to audit all aspects of Electronic Health Record.
- Audits medical records for compliance.
- Develops and enhances audit reports for medical records.
- Develops and enhances Clinical Documentation Improvement function.
- Develops and enhances audit procedures.
- Completes weekly and monthly expectation & audit reports for administration.
- Identifies opportunities for improvement.
- Provides input for provider newsletters and feedback to the Clinical Adoption team on training issues.
- Maintains current knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards.
- Assists the Clinical Technology Services teams in the design and configuration of system enhancements.
- Participates in the Rogers Improvement System (RIS) program.
- Promotes a team atmosphere by treating individuals with respect and honesty and by using direct communication and active listening skills.
- Performs other duties as assigned.
Requirements
- Associates degree or five (5) years of equivalent experience working in a health care environment.
- Credential: RHIA, RHIT, CCS, CCS-P, CDIP, CPMA, or CPC.
- Completion of anatomy & physiology, pathophysiology, pharmacology, medical terminology, reimbursement methodology, intermediate/advanced ICD diagnostic/procedural and CPT coding courses.
- Minimum of two (2) years' experience of related coding experience directly applying codes, preferably in a psychiatric setting.
- Proven success in facilitation and training.
- Computer proficiency and working knowledge of software programs, including Windows packages.
- Valid Wisconsin driver license.
Benefits
- Health, Dental & Vision Insurance
- 401(k) Retirement Plan
- Employee Share Program
- Life/Disability Insurance
- Flex Spending Accounts
- Tuition Reimbursement
- Health and Wellness Program
- Employee Assistance Program (EAP)
Company overview
Rogers Behavioral Health is a nationally recognized, not-for-profit provider of highly specialized psychiatric care with over a century of experience in the mental health field. Founded in 1907 and headquartered in Oconomowoc, Wisconsin, the organization operates a growing network of treatment facilities across the United States. Rogers specializes in evidence-based treatment for children, teens, and adults with a comprehensive range of mental health conditions including OCD and anxiety disorders, addiction, depression and other mood disorders, eating disorders, trauma, and PTSD. The organization employs over 200 medical professionals, including more than 100 board-certified psychiatrists and psychologists, who collaborate with behavioral specialists, nurses, therapists, and dietitians to provide individualized care. Rogers is distinguished by its measurement-based care approach and clinical outcomes research, operating a dedicated Research Center that advances treatment methodologies through genetics studies, pharmacogenomics, and innovative therapeutic interventions. The organization offers multiple levels of care including inpatient, residential, day treatment, and intensive outpatient programs, maintaining a strong commitment to trauma-informed, patient-centered treatment across all its nationwide locations.