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Work Shift

Job Summary:

The Lead Inpatient Coder serves as a key expert in ICD-10-CM, ICD-10-PCS, and DRG assignment, providing specialized knowledge and guidance to the Inpatient Coding team. This role is responsible for addressing complex coding questions, reviewing, and resolving external audit findings, and contributing to coding improvement initiatives. Additionally, the Lead Inpatient Coder plays a critical role in delivering ongoing education and training to the coding team, helping to minimize coding errors and ensure compliance with industry standards. By identifying opportunities for process enhancements, the Lead Inpatient Coder supports the continuous improvement of coding practices, ensuring accurate and efficient coding across all inpatient cases.

Core Responsibilities and Essential Functions:

Expert Resource for ICD-10-CM/PCS and DRG Assignment: Serves as a go-to expert for all questions related to inpatient coding, including ICD-10-CM (diagnosis codes), ICD-10-PCS (procedure codes), and DRG (Diagnosis-Related Group) assignment. Reviewing Coder Questions: Reviews coding-related questions to ensure that coders have the correct information for accurate coding. Providing Input and Assistance: Provides coders with answers and guidance, utilizing references including but not limited to Coding Clinic, Coding Guidelines, and internal policies to ensure compliance and accuracy. Logging Coder Feedback: After answering a question, log the feedback and send the necessary evidence to the coder to ensure transparency and reference for future work. Developing Internal Log of Frequent Coding Questions: Maintains an internal log to track recurring coding issues and frequently asked questions, which helps identify gaps and develops education for potential areas where additional training or clarification is needed. Monthly Meetings with Inpatient Coding Supervisors/Manager: Meets with inpatient coding leadership monthly to discuss trends, challenges, and potential opportunities for process improvement based on feedback from coders and analysis of coding trends. Reporting and Education: Manages monthly reports and provides coder education. Update Coder Profiles: Updates and shares results with Coding Team from Prebill, Random, and External audits each month. Reporting: Generates and shares weekly Prebill reports with coders and clients. Create Excel Worksheets: Creates performance tracking worksheets for each coder. Education: Provide Monthly Education: Develops coder education and training related to relevant review findings. Develop System/Technology/Workflow Optimization: Assesses, recommends and monitors hard stop edits and other system automation and optimization in coding workflows based on audit trends to prevent errors. Internal Reviewer for Rebuttals: Reviews and assesses coder rebuttals for both internal and external coding audits. This includes determining whether the coding decisions made are accurate or need adjustment based on the audit feedback. Maintaining the Rebuttal Log: Responsible for tracking of all rebuttals, ensuring that there is a clear and organized log of the decisions, responses, and outcomes from these rebuttals. Reviewing Rebuttals: After an internal or external coding audit, reviews the rebuttals submitted to ensure they are in alignment with coding standards, guidelines, and any legal or regulatory requirements. Shares Rebuttal Outcomes: communicates resolution of rebuttals with all stakeholders once the process is complete. Coding Query Reviewer: Oversees the query review process for both internal and external inpatient coders, ensuring all queries are accurate, follow coding guidelines, and align with medical documentation before being sent to providers. Assesses each query for accuracy and justification, submitting appropriate queries to providers for clarification. Additionally, monitors coder query accuracy rates to assess whether accuracy threshold is consistently being met. Communication with Inpatient Coding Supervisor/Leader(s): Once a coder reaches the required accuracy threshold, notifies the inpatient coding supervisor that the coder can be removed from the query review process, signaling that they are consistently meeting the accuracy requirements. Performs other duties as assigned Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• High School Diploma General or GED General
• Associates Health Information Management-Preferred

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

AHIMA - American Health Info Mgt Cert Upon Hire Preferred or RHIA - Reg Health Information Admin Upon Hire Preferred or RHIT - Reg Health Information Tech Upon Hire Preferred or CCS - Cert Coding Spec Upon Hire Preferred or

Required Minimum Experience:

Minimum 4 years Acute care inpatient coding Required

Required Minimum Skills:

Must have demonstrated maintenance of a or higher accuracy in abstracting, code and DRG assignment while meeting productivity requirements in previous roles High Ability to work efficiently a remote environment High Ability to communicate with various members of the healthcare team High Proficiency and experience with Microsoft, Epic EMR, Solventum Encoder/3M 360 High Computer/data entry experience High

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