PACE Medical Coding Lead (Hybrid)
8080 Dagget St, San Diego, CA 92111, USA Req #8094
Position Summary:
The PACE Medical Coding Lead will review clinical documentation and diagnostic results as necessary to verify the appropriate assignment of the ICD-10 CM, CPT and HCPCS codes as per Official Guidelines for Coding and Reporting. While reporting to the PACE Coding Manager, will work collaboratively to perform coding training, audits, research, and assist with special projects.
This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to work on-site at least once per month; additional on-site presence may be required based on business need
Essential Functions of the Job:
Performs coding training, coding audits, provider audits, research, scheduling, and special projects assigned by the PACE Coding Manager
Responsible for monitoring coding work queues, including deployment of coders to areas of greatest need
Assist with education in-services for physicians, other providers and clinical staff relating to documentation, coding and charging guidelines
Perform research, run various reporting and assist with general coding as needed and as requested
Monitor coding operations with respect to workflows and regular reporting: evaluate workflows for maximum efficiencies and problem solve work queue issues when accounts/charges are not flowing properly, making recommendations as necessary
Maintain updated documentation of all workflows
Codes complicated medical charts exceeding 50 diagnoses
Determines all HCC codes associated with patient encounters
Keeps up to date with the latest CMS risk adjustment guidelines
Reviews Chart Progress Notes, patient documentation for diagnoses, procedures, and services performed by physicians and other qualified healthcare providers
Verifies all diagnostic procedural codes from the electronic health record using ICD-10 CPT and HCPCS coding classifications
Communicates effectively with providers concerning documentation to assure proper coding and reimbursement
Identifies all chargeable items within each progress note to ensure proper CPT/HCPCS codes for each of the items
Applies sequencing guidelines for the diagnosis codes and selection of the principal diagnosis and procedure according to ICD-10 guidelines
Tracks open/close encounter reports to assure that all patients seen in the clinic are properly coded
Organizes & prioritizes all work to ensure that records are coded in time frames that will be in line with department policies
Maintains knowledge of Anatomy & Physiology to interpret general medical classifications for coding including the most complicated encounters/cases
Acts as an expert resource person to other coders & personnel in other departments regarding coding questions & issues
Participates in ongoing education, including in-service training and other activities to maintain and improve competence
Adheres to SYHC's Core Competencies and professional Code of Conduct Behavior Standards in their day-to-day work by consistently demonstrating the Core Values of Respect, Excellence, Integrity and Empowerment
Additional Duties and Responsibilities:
Adheres to all applicable SYHC's Policies, Procedures and processes
Demonstrates skills in collaboration with team and problem-solving
Excellent written and oral communication skills
Enhances professional growth and development through participation in educational programs, current literature, in-service meetings and workshops
Attends meetings as required and participates on committees as directed
Demonstrates courtesy and treats every patient and employee with dignity in every interaction
Assists in the maintenance and/or revision of established Departmental Policies and Procedures
Maintains confidentiality of all patient electronic medical records
Maintains a clean, safe, and organized work area at all times
Performs all other related duties as assigned or requested
Job Requirements
Experience Required:
One (1) year of medical coding experience required with a CPC, CRC, or CCS
Education Required:
High School Diploma or GED Equivalent
Certifications Required:
Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC), Certified Professional Medical Auditor (CPMA), or Certified Professional Compliance Officer (CPCO) from the American Academy of Professional Coders (AAPC)
Or, Certified Coding Specialist (CCS) from the American Health Information Management Association (AHIMA)
Verbal and Written Skills Required to Perform the Job:
Good written and verbal communication
Strong communication and presentation skills
Comfortable speaking with people at an executive level or physician level
Technical Knowledge and Skills Required to Perform the Job:
Superb organizational ability and exceptionally analytical
Experience and knowledge with Microsoft Office software
Equipment Used:
Company’s Laptop, occasionally personal phone
Working Conditions and Physical Requirements:
This position is intended to be a hybrid role, where the incumbent will be expected to primarily work remotely. There is a minimum expectation to work on-site at least once per month; additional on-site presence may be required based on business need
Long Irregular hours; may work weekends
Prolonged periods of sitting, and constant walking and standing
Driving and occasional travel required
Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
