Lead Certified Coder
Under limited supervision, the Coding Leads work with the Manager in the daily operations of the Coding Department. Works with Coders in answering questions and follow up emails to providers. Maintains department spreadsheets. Review, analyze and assign final EM levels, any office procedures and all diagnoses reflected in the provider chart notes according to CMS guidelines and GoHealth UC protocols. Works with our partners and markets to resolve problems, research new programs, updates protocols. Helps train new coders.JOB REQUIREMENTS
High School Diploma or GED required
Associates Degree preferred
Work Experience Required
Minimum of 5 years outpatient EM/office procedure coding
Minimum 1 year working with coders in auditing/education
Knowledge of revenue cycle
Medical Coding Certificate - RHIT or CPC certification
Additional Knowledge, Skills and Abilities Required Federal laws and regulations affecting coding requirements
Working knowledge of payor guidelines, ie-modifier usage, timely filing
Strong Knowledge of Excel
Knowledge of billing practices
Knowledge of Epic and eCW EMR required
Excellent Communication Skills
Additional Knowledge, Skills, and Abilities Preferred
Experience working with computer assisted coding
Duties May Include:
• Point person for the Market Specialists, outsourced coding and CAC emails and questions
• Review and analyze CAC and Market processes for continued department improvement.
• Point person for research in new market programs and processes that include coding changes.
• Review’s pending WQ’s for timely follow up by coders.
• Review Code Correct Errors for trends. Report patterns and potential coding changes.
• Trains new coders in each Market and CAC system.
• Works with off shore team to ensure GH processes and protocols are followed.
• Maintains Market Specific Guide’s and ensure contact list is up to date in the assigned Market.
• Works to ensure a smooth process in each Market
• Meets weekly with the Market Specialist, keeps ticket spreadsheet current w/in 2 weeks.
• Accurately follows CMS coding guidelines and GoHealth Protocols to ensure compliance with federal and state regulatory bodies
• Alerts Coding Manager to any market trends for additional coder/provider training
• Provide feedback to Coding Manager on any Market issues
• Reviews Coder Time/Productivity Quarterly as sent by Manager
• Is the Coder point person for coding/GH Process Questions.
• Approves all Time Off and ensures the coders add their time off to the Coders Time Off Calendar.
• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
• Meets with Manger/Coders to review yearly goals.
• Maintains Coder productivity spreadsheets.
• Codes weekly in each of the assigned Markets
• Attends seminars and in-services as required to remain current on coding issues
• Maintain current coding certificate
• Performs other related duties as assigned