Lead, Professional Services Coder - PFS - RCSSD

JOB SUMMARY

Under the general direction of the Supervisor, Professional Billing & Coding and Director, Professional Billing & Coding, this position operates from within the Revenue Cycle Center to address coding issues related to professional billing claims. The incumbent is responsible for reviewing provider charges to ensure accuracy, reduce claim errors & denials while maintaining compliance with CCI & other payer specific coding Edits (McKesson). The incumbent is responsible for reviewing professional surgical coding performed by departmental Professional Services Coders to ensure accuracy. The incumbent will be responsible for identifying trends of incorrect coding & compiling examples. They will develop training guidelines & presentations of coding recommendations based on these identified trends & will meet with physician providers to train & educate. The incumbent will research CCI Edits, coding & payer websites to provide up-to-date information to coding & billing staff, as well as providers. The incumbent will monitor, track & report error & denial trends to Revenue Cycle Leadership. The incumbent will recommend coding changes based on audit & research. The incumbent will assist departments with resolution of claim errors stemming from coding errors. Responsible for processing patient complaintss related to a patient account/invoice. Responsible for establishing & maintaining accurate development of procedural coding for clinical services following Federal & State guidelines. Coordinate & delegate workflows of surgical coding staff. Serve as a resource & mentor to the Departmental Certified Coders & billing staff, assisting them with education & coding questions as they arise. Must be knowledgeable in ICD, CPT & HCPCS coding. Must understand & apply all regulations/laws/and standards applicable to coding to ensure appropriate & compliant billing.

MINIMUM QUALIFICATIONS

H.S. Diploma,GED,or Equivalent

2 Years of Experience

Certified Professional Coder

Knowledge of coding methodology, abstract coding from medical/chart notes and operative reports.

PREFERRED QUALIFICATIONS

Associate's Degree

3 Years of Experience

The expected hiring range for this position is $25.47 to $35.03

Rady Children's Hospital is committed to compensation that is externally competitive and internally equitable. We demonstrate this commitment by conducting regular market reviews to remain competitive with organizations of similar size in the nonprofit, healthcare sector. The range listed above does not represent the full salary range for the position but is the expected hiring range for qualified candidates. Compensation decisions consider a variety of factors including experience, education, licensure, unique skillsets, organizational need, and internal equity.

EOE including disability/vet