Outpatient Coder Lead (Occasional Onsite Required)

The Health Information Management Outpatient Coding Specialist Lead provides timely and accurate clinical and administration data to ensure optimal reimbursement for facility outpatient, ambulatory surgery, observation and recurring accounts to support the facility coding needs. The Lead OP Coder serves as the first contact for coding issues before escalation to management, coordinates and leads training of new coders, gathers and disseminates updates, and works closely with the manager to evaluate and implement process improvements or regulatory updates. This role involves auditing, monitoring coder performance, developing educational materials, and ensuring adherence to coding guidelines including CPT assignment, CCI edits, and modifiers.

Additional responsibilities include demonstrating excellent customer service, maintaining positive communication and confidentiality, collaborating with HIM leadership and other departments, addressing coding-related external vendor issues, monitoring workflow to meet turnaround time goals, participating in departmental meetings and initiatives to improve coding efficiency, maintaining professional credentials, and supporting various departments such as Finance, Data, and Patient Safety in coding and billing follow-up.

The position requires adherence to HIPAA regulations and departmental policies, participation in goal setting, performing other duties such as denial analysis, appeal letter writing, coding quality reviews, mentoring students, and upgrading software testing.

Qualifications:

• RHIA, RHIT, or CCS credential required or eligible candidates with a Bachelor or Associate Degree expected to pass the national exam
• Minimum of three years acute care outpatient coding experience including ICD-10-CM and CPT-4 coding, NCCI edits, and modifiers
• Ability to perform under stress with deadlines and frequent interruptions
• Proficient with computer applications including EMR, Outlook, encoder software, and standard office software
• Effective verbal and written communication skills, sound judgment, problem solving, interpersonal skills, and organizational abilities
• Flexibility to adjust assignments as priorities change

This role demands long periods of computer work and requires leadership in adherence to outpatient coding standards and process improvements.