Lead Coder, Hospital OP Coding

Coder Lead

The Coder Lead will code all outpatient types as needed; same-day surgery, ancillary, ambulatory and provider based clinics. This individual will mentor, train and assist with cross training coding staff, includes newly hired coding staff. Must be familiar with reviewing documentation to assign appropriate CPT/HCPCS and ICD-10-CM-PCS diagnosis codes and procedures for hospital and physician (professional) services for Inpatient and Outpatient records based on knowledge of coding systems, including ICD-10 and CPT.

Your Everyday

• Proficiently navigates the patient health record and other computer systems/sources to accurately determine diagnosis and procedures codes, MS-DRGs and APCs.
• Codes complex outpatient or inpatient utilizing encoder software, Computers Assisted Coding (CAC), and reference, in the assignment of ICD-10-CM/PCS, CPT/HCPCS codes, MS-DRG, APR-DRG, POA, SOI, ROM assignments, APC assignment and all required modifiers.
• Validates charges by comparing charges with health record documentation as necessary.
• Utilizes retrospective edit tool to address possible coding and/or documentation issues related to submitted diagnosis and procedure information obtain from the health record.
• Communicates effectively with clinical staff, physicians and office staff and Clinical Documentation Improvement Specialist regarding documentation issues or needs related to Inpatient, Outpatient, or Ambulatory coding.
• Identifies concerns and notifies appropriate leadership for resolution. Responsible for providing resolution to moderate to complex problems.
• Tracks issues (i.e. missing documentation, charges and physician queries) that require follow-up to facilitate coding in a timely fashion.
• Consistently meets or exceeds coding quality and productivity standards established by coding department.
• Adheres to LCMC confidentiality requirements as they relate to release of any individual or aggregate patient information.
• Maintains up-to-date knowledge of changes in coding and reimbursement guidelines and regulations.
• Performs other duties as assigned by leadership.
• Maintains working knowledge of applicable coding and reimbursement Federal, State and local laws and regulations, the Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior.

The Must-Haves

Experience Qualifications

• Minimum three (3) years of current complex outpatient and inpatient coding (required)

Education Qualifications

• Required: Completion of an American Health Information Management Association (AHIMA) approved coding program or an American Academy of Professional Coders (AAPC) approved coding program
• Required: Associate degree in health information management or related field or an equivalent combination of years of education and experience

Licenses and Certifications

• Certification Name: Certified Coding Specialist (CCS) Required
• Issuer: American Health Information Management Associations (AHIMA) or American Academy of Professional Coders (AAPC)
• Certification Name: Certified Inpatient Coder (CIC) Required
• Issuer: American Health Information Management Associations (AHIMA) or American Academy of Professional Coders (AAPC)
• Certification Name: Certified Professional Coder (CPC) Required
• Issuer: American Health Information Management Associations (AHIMA) or American Academy of Professional Coders (AAPC)
• Certification Name: RHIA/ RHIT certification Issuer:
• Certification Name: Internal staff who are not certified must obtain medical coding certification within twelve months through an approved LCMC coding program. Required

Skills and Abilities

• Extensive comprehensive working knowledge of medical terminology, anatomy and physiology, diagnostic and procedural coding and MS-DRG or APC grouping.
• Experience utilizing encoding/grouping software.
• Ability to use standard desktop and windows based computer system, including basic understanding of email, internet, and computer navigation.
• High ethical standards.
• Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPCS, MS-DRG, APR-DRG and APC coding principles and guidelines.
• Experience in ICD-10-CM/PCS coding and reimbursement training.
• Knowledge of Prospective Payment System (PPS) methodology for inpatient, outpatient, ambulatory and provider-based clinic encounters.
• Extensive knowledge of hospital and professional coding including provider based billing.
• Knowledge of documentation regulations of Joint Commission and CMS.
• Experience with concurrent coding reviews.
• Knowledge of privacy and security regulations, confidentiality, laws, access and release of information practices.
• Experience in assisting and identifying learning needs as well as providing training to coding staff.
• Strong analytical abilities and problem-solving skills.
• Excellent oral, written and interpersonal communication skills.
• Ability to organize and set priorities to ensure objectives are met in a timely manner.
• Ability to adapt to change and handle challenges proactively and with pose.
• Ability to effectively collaborate with physicians and managerial staff at all levels.

Work Shift: Variable Hours (United States of America)

LCMC Health is a community. Our people make health happen. While our NOLA roots run deep, our branches are the vessels that carry our mission of bringing the best possible care to every person and parish in Louisiana and beyond and put a little more heart and soul into healthcare along the way. Celebrating authenticity, originality, equity, inclusion and a little "come on in" attitude is the foundation of LCMC Health's culture of everyday extraordinary.

Your extras

• Deliver healthcare with heart.
• Give people a reason to smile.
• Put a little love in your work.
• Be honest and real, but with compassion.
• Bring some lagniappe into everything you do.
• Forget one-size-fits-all, think one-of-a-kind care.
• See opportunities, not problems it's all about perspective.
• Cheerlead ideas, differences, and each other.
• Love what makes you, you - because we do.

LCMC Health is an equal opportunity employer. All qualified applicants receive consideration for employment without regard to race, color, religion, sex, national origin, sexual orientation, gender identity, disability status, protected veteran status, or any other characteristic protected by law.

The above job summary is intended to describe the general nature and level of the work being performed by people assigned to this work. This is not an exhaustive list of all duties and responsibilities. LCMC Health reserves the right to amend and change responsibilities to meet organizational needs as necessary.

To get started, take your time to fully and accurately complete the application for employment. Incomplete applications get bogged down and are often eliminated due to missing information. To ensure quality care and service, we may use information on your application to verify your previous employment and background. To keep our career applications up-to-date, applications are inactive after 6 months and, therefore, require a new application for employment to be completed. To expedite the hiring process, proof of citizenship or immigration status will be required to verify your lawful right to work in the United States.