Coding Team Lead

•Qualifications

• Must possess CPC from AAPC
• Must possess a BS in Nursing, Allied Health or similar areas
• Must have minimum of 1 year of Coding Analytics Experience
• Must have 2 years of Coding Experience
• Must have Advanced English Writing and Reading
• Must pass a Pre Screening Evaluation

•Duties

Team Lead is responsible for the output of the team.  They are to ensure that all team members meet written guidelines for productivity, quality and behavior. To do this they will:

• Review the feedback from Coder and Quality Control related to code assignment for ICD-10-CM, HCPCS and CPT
  • DAILY TASK: This will involve working in MaxCode or other coding applications in a QC or Manager role and personally reviewing for a minimum of 50% of your day. This would be the 1st priority for clients that are in Production and will take precedence over any other task. This will include a written summary of the observation identified during your review. This observation will be used as a benchmark for your team and used to understand potential areas of mistakes and risks within the coding workflow. The written summary may include coder name, client, category of mistake (Demographics, ICD, CPT, E&M, Modifier, MetaData). If the said client has appropriate reporting in MaxIntel to identify the changes of the Team Lead, then the written summary will be derived from that report versus a manual process.
  • For clients that are not in Production, this will be in the top 3 priorities of your day and will include a written summary of the observation identified during your review. This observation will be used as a benchmark for your team and used to understand potential areas of mistakes and risks within the coding workflow.
  • This written summary will be placed in a centralized location where Management can also locate and review as needed. It will be updated daily and will be used to gauge additional training that will be needed for your team.
  • The rebuttals spreadsheet in the shared drive must be checked daily to ensure that it is updated with feedback from the coders. Reminders to the coders must be sent if it is not updated. The feedback from the coders must then be submitted to QC and Management for review. When applicable, recommendations to updates in the idios/Client Coding profile must be submitted to management for approval to help standardize coding and avoid repetitive coding inconsistencies between coders.
• Track and monitor Quantity and Quality of coder and report to Management and coder
  • BI-WEEKLY TASK: Reviewing the quantity and quality of the coder and ensuring they are meeting expectation. This will be done using the User prod by Role report in MaxIntel and the Quality Report in MaxIntel. In lieu of the Quality Report, a sample of the coder's charts can be used to derive the overall accuracy of the coder by breaking down the following categories: Demographics, ICD, CPT, E&M, Modifiers, MetaData

• Analyze coding trends and patterns to provide formal observations and recommendations
  • WEEKLY TASK: This involves working with the Coding Analyst in tracking the EM bell curve and studying the cause for any shifts in coding. These shifts will need to be reported to management, along with action plans on how to keep the EM bell curve more consistent.
  • MONTHLY TASK: Changes to volume or workload must be monitored and identified in making recommendations and action plans to ensure proper staffing and completion of coding queue. This will be done by using the MaxIntel report for Control Count which will show the volume received by the Client/Location.
  • WEEKLY TASK: TL will utilize the Docu-Pending, FYI Deficiency and client facing reports (Documentation Opportunities and DocuCQC Summary) to identify changes with how the team is capturing MetaData. Changes would include: increased or decreased EM deficiencies, improvements in QM deficiency, questionable deficiency, DocuCQC or Pending items that are inconsistent with historical data, shifts in capturing specific DocuCQC reasons.
  • BI-WEEKLY TASK: TL will utilize the CPT Code report or All Data report to understand how the coders are assigning their EM levels as well as Procedure codes. The All Data will be used to understand how the coders calculate their EM levels by reviewing the Box A, B, C and Problem Severity columns to compare with their final EM selection.
• Track, report and monitor educational opportunities for providers and coders
  • WEEKLY TASK: This involves sending weekly feedback to Management based on observations from documentation deficiencies or metadata that are frequently captured by the coders or from common issues coders are bringing up during team huddles.
  • DAILY TASK: This includes working on Sequel Med or other PM systems to check on denials, payor requests and billing concerns and providing feedback to coders on coding issues that caused the denials. This will be reported to the coders during the daily team huddle.
  • AS NEEDED TASK: This also means working on Coding Validation exceptions in MaxCode, taking note of the causes of these exceptions, providing recommendations and implementing action plans to prevent these from recurring.
  • DAILY TASK: When items are identified as incorrectly coded and have already been submitted to Billing, these are called Latent Errors. In instances when a latent error is identified either from QA/Compliance, Coding Validation, PM tasks or via email, the error will be counted against the current month in which the error was found.
  • MONTHLY TASK: Reviewing the QA/Compliance feedback and providing your final recommendation on coding. Following that summary, TL will have a coaching session with the coders which includes a detailed action plan to prevent the same errors from recurring.
• Prepares and leads on the job training and in-services as required to remain current on coding issues
  • This involves working with the SMEs in staying current on updates to coding guidelines and researching on its proper implementation so proper training may be conducted for the coders.
  • This also includes reviewing the work of coders after an update has been implemented to track changes in coding and ensuring that coders are correctly capturing codes based on training.
• Track relevant metrics daily, weekly and monthly and report those to the Supervisor or Business Manager over their department.
  • AS NEEDED TASK: Intervene where team members are not meeting objectives and prepare guidance on how they can improve.
  • Ensuring that team members who violate any policy in the code of conduct or the department's house rules are disciplined properly. This means that proper disciplinary action must be discussed, implemented and documented with the employee, management and HR, based on the severity of the offense. HR paperwork in disciplining team members must be filed with HR.
  • MONTHLY TASK: Preparing and submitting monthly scorecards and incentive recommendations for each team member that should include at least include the following metrics: Attendance, Quality of Work, Productivity, Client Feedback, Training Performance, and Company Values.
  • Scorecards and incentive recommendations must be submitted to management for approval every 10th calendar day of the following month. For example: Scorecards for the month of January must be completed and submitted on or before February 10.
  • SEMI-ANNUALLY TASK: Semi-annual Performance evaluations for each team member must be prepared and submitted to management for final review so these can be discussed with each coder.
• Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
  • AS NEEDED TASK: Staying up to date on coding guidelines and client directives.
• Ensure team members are in attendance and actively engaged in their work.
  • DAILY TASK: Daily reporting attendance to their direct report as well as to the point of contact(s) designated to their team members.
  • This includes checking the absent/late notifications tracker and Time logs tracker from HR and updating the Cebu Public Calendar with the instances of absences and tardiness incurred by team members.
  • This also means that the Coding Lead should make sure that there aren't too many coders that are on leave on the same dates or on critical work days by discussing employee leave requests with management prior to approval, updating the Cebu Planned Leaves calendar when these are approved and discussing the reason for disapproval with employees if these are disapproved.
  • Having one on one meetings to assess the cause and to provide coaching with any employee who is absent or tardy. This includes coordinating with HR and management to report instances of AWOL, absenteeism and excessive tardiness, making recommendations on corrective action to address the attendance issues and implementing the corrective actions
  • Building a culture of inclusion and a team that respects one another so all feel included and important.
• Maintains compliance standards in accordance with the Compliance policies and the Code of Conduct. Reports compliance problems appropriately.
• Directly reports to Coding or Site Manager

•Skills

• Ability to analyze medical records and coding guidelines
• Ability to use computer at advanced level
• Understand, delegate and carry out verbal and written direction
• Participate in daily, weekly and/or monthly meetings via telecommunication
• Ability to manage department in the absence of direct supervision
• Ability to work in a fast paced and production environment
• Ability to research topics related to job outside of normal business hours and present to team
• Ability to work in an office setting for minimum of 8 hours a day, 5 days a week.

Current Openings for Coding Team Lead Jobs at PMAX Global