Lead Assistant Manager-Auditors-DRG
Medical Coding Team Lead - Surgery & Payment Integrity is responsible for overseeing a team of medical coding specialists to ensure accurate, compliant, and timely auditing of surgical procedures across multiple specialties. This role demands strong technical expertise in CPT, ICD-10, and HCPCS coding, particularly within DRG coding domains
Team Leadership & Management: Lead, mentor, and manage a team of medical coding specialists to deliver high-quality auditing outcomes. Foster a collaborative, accountable, and performance-driven team culture.
Quality & Compliance: Ensure all coding and auditing activities adhere to the latest industry standards, payer guidelines, and regulatory requirements. Conduct regular audits to maintain accuracy and compliance.
Training & Development: Provide continuous education, coaching, and feedback to the coding team to enhance their technical skills and domain expertise.
Workflow Oversight: Manage coding workflow, prioritize daily assignments, and monitor progress to ensure timely completion of audit deliverables and achievement of productivity and accuracy targets.
Regulatory Updates: Stay abreast of changes in coding guidelines, payer policies, and CMS updates. Effectively communicate these updates and their operational impact to the team.
Cross-Functional Collaboration: Partner with analytics, repricing, compliance, and quality departments to resolve coding discrepancies, streamline processes, and enhance overall audit efficiency.
Performance Monitoring: Track key performance indicators (KPIs), identify performance gaps, and develop improvement strategies to boost team productivity and quality outcomes.
Payment Integrity: Apply strong knowledge of payment integrity principles to identify claim errors, documentation deficiencies, and missed revenue opportunities, ensuring optimal claim accuracy and reimbursement.
Subject Matter Expertise: Act as a coding and auditing expert for surgical specialties, supporting physicians, clinical teams, and business stakeholders in achieving accurate and compliant documentation and coding practices
- Bachelor's degree in Clinical or Healthcare Information Management or a related field.
- Relevant certifications (e.g. CPC,CIC,CCS for DRG) are mandatory.
- Extensive experience in medical coding, with a focus on DRG coding and strong knowledge of CPT, ICD-10-CM, HCPCS coding systems.
- Proficient in using coding software and electronic health record (EHR) systems.
- Strong analytical and problem-solving skills, with the ability to identify coding-related issues, propose solutions, and implement process improvements.
- Excellent interpersonal and communication skills, with the ability to collaborate effectively with diverse stakeholders and build positive relationships.
- Detail-oriented with a commitment to accuracy and compliance with coding guidelines and regulations.
- Ability to work independently, prioritize tasks, and meet deadlines in a fast-paced environment.
- Demonstrated knowledge of healthcare industry regulations such as HIPAA and HITECH, and specific knowledge of CMS, Medicare, LCDs, NCDs, Medical Policies, Commercial payer processes and requirements.
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- Lead and manage a team of medical coding specialist ensuring accurate and timely auditing of procedures across various specialties in accordance with industry standards, guidelines and regulatory requirements.
- Provide guidance, training, and mentorship to the coding team, fostering a collaborative and high-performing work environment.
- Oversee the coding workflow, prioritize work assignments, and ensure productivity and quality targets are met or exceeded.
- Stay updated with changes in coding guidelines, payer policies, and industry trends related to surgery coding and payment integrity process and effectively communicate these changes to the team.
- Conduct regular audits and quality checks to ensure compliance with coding guidelines, accuracy of coded data, and adherence to documentation requirements.
- Collaborate with other departments, such as analytics, repricing, quality, compliance to optimize coding processes and resolve coding-related issues.
- Monitor key performance indicators (KPIs) and develop performance improvement initiatives to enhance auditing efficiency, accuracy, and productivity.
- Apply payment integrity processes and knowledge to ensure proper coding and billing practices, identify claim and documentation errors and deficiencies, and maximize revenue capture.
- Serve as a subject matter expert on multi-specialty surgery coding and payment integrity, providing guidance and support to physicians, clinical staff, and other stakeholders to ensure appropriate documentation, coding, and auditing practices
