Lead Medical Coding Specialist

The Lead Medical Coding Specialist works in conjunction with the Coding Supervisor to ensure accuracy, consistency and efficiency in relation to code assignment for reimbursement and reporting purposes. The Lead Medical Coding Specialist will complete quality reviews for coding staff in order to validate code and reimbursement assignments. This position is a “working” Lead position and is expected to work alongside staff as well as provide direction.

• A minimum of a High School Diploma or GED, required
• CPC, CPC-H, CPC-P, CEDC or, CCS, preferred
• 4+ years experience coding ICD-10-CM, HCPCS and CPT codes, required
• 3+ years supervisory experience, required
• Experience coding emergency or hospital facility and ancillary services, preferred
• Experience coding inpatient and observation services, preferred
• Experience in applying IV infusion and injection codes, preferred
• Expertise in pathophysiology, anatomy, medical terminology, coding systems, techniques and procedures, preferred
• Proficiency using Microsoft Office Tools (Microsoft Word, Excel and Outlook)
• Proficiency using patient accounting systems and electronic health records, required
• Knowledge of all Health Insurance Portability and Accountability Act (HIPAA) guidelines and regulations, required
• Position requires fluency in English; written and oral communication

• Assist Coding Supervisor in the supervision of Medical Coding staff for Emergency Facilities, Inpatient, Observation, and Ancillary services coding
• Assists in managing staffing schedule and departmental overtime
• Performs quality review of staff for accuracy/efficiency and identifies charge capture opportunities
• Completes metric reporting as required by agreed upon deadlines and assists in month‑end close processes
• In conjunction with the Coding Supervisor, ensures standard metrics are consistently met by coding staff and develops corrective action plans as necessary
• Provides training/oversight for new staff
• Serves as liaison between Coding Team and Coding Supervisor
• Works closely with other Intra‑CBO Departments for proper resolution of coding and charge capture items as they relate to claim submission and resubmission of claims.
• Management and oversight of coding related claim rejections
• Utilizes various reports to ensure proper and timely submission of claims for billing
• Compile data reports for Coding Supervisor, CBO Director, Executive Leadership, Medical Directors, and Hospital Administrators as needed
• Expected to participate as a team member for record completion on an as‑needed basis (i.e., provide coverage for weekends, holidays, vacation and if coder productivity falls behind an established expectation). Duties will include:
  • Review clinical documentation and diagnostic results to extract data and apply appropriate ICD-10-CM and CPT‑4 codes, including IV infusion and injection codes
  • Review clinical documentation and diagnostic results to extract data and apply HCPCS and facility‑level Evaluation & Management codes for billing
  • Abstract and code diagnoses and procedures from health records by using appropriate classification systems

• Attend staff meetings or other company‑sponsored or mandated meetings as required
• Perform additional duties as assigned
• Ability to work weekends/holidays and overtime on an as-needed basis

• Associate

• Full‑time

• Health Care Provider

• Hospitals and Health Care