Lead Physician Coder
Miami Children's Hospital - Miami, FL

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Job Title : Lead Physician Coder


Works under the direction Director and Manager. Responsible for being the lead of the physician coders and timely review of patient records in order to identify an appropriate selection of codes which will accurately reflect the reason for admission, extent of care received and level of severity of illness. Performs any ad-hoc coding projects as requested by the Director or Manager. Performs coding audits concurrently and/or quarterly for surgical and non-surgical procedures in each of the offices and reports findings to the department Director or Manager.

Minimum Requirements

*High school education or equivalent

*3 - 5 years’ experience with physician billing coding and compliance required

*Certified Professional Coder and/or Certified Coding Specialist – Physician required

*Bachelor's Degree or Associate Degree in Health Information Management or related field and/or equivalent healthcare business experience.

*Proficiency in coding physician practice and surgical procedures

*Proficiency in presentation skills a must to a varied audience

*Exceptional knowledge of PC applications such as PowerPoint, Excel and Word

*Exceptional understanding and knowledge of state regulations for physicians' compliance and coding rules.

*Knowledge of managed care regulations regarding patient type criteria and appropriateness of patient type statues by healthcare professional when admitting patients as Outpatient, Observation or Inpatient.

*Outstanding analytical and organization skills with attention to detail.

*Ability to communicate effectively in English both verbally and in writing.

*Basic knowledge in use of computers and printers and/or ability to learn appropriate software application(s).

*Able to maintain confidentiality of sensitive information and adapt to frequent changes in assignments

*Able to relate cooperatively and constructively with customers and co-workers

*Proficient in alphabetical and numerical filing systems

*Good organizational skills.

Additional Job Duties

*Maintains knowledge of and follows relevant departmental and MCH policies and procedures

*Participates in annually mandated MCH / department education/training initiatives.

*Participates in Operations Committee and other committee meetings as needed

*Other duties as assigned

Physical Requirements

*Lifts Weights Or Exerts Force As Of Pushing And Pulling - Must Frequently lift and/or move up to 10 Pounds

*Lifts Weights Or Exerts Force As Of Pushing And Pulling - Must occasionally lift and/or move up to 25 pounds

*Noise Tolerance - Moderate - less than 85 decibels (examples: business office with computers and printers, light traffic, riding in truck, receptionist area)

*Sit - Regularly Required

*Stand - Frequently Required

*Use Hands To Finger, Handle, Or Feel (Manual Dexterity) - Occasionally Required

*Vision - Ability to adjust focus - ability to adjust the eye to bring an object into sharp focus, i.e. shifts gaze from viewing a computer monitor at a distance of several feet to forms that are closer to compare data at close vision

*Vision - Close vision - ability to see clearly 20 inches or less

*Walk - Frequently Required

Work Environment

*Outdoor Weather Conditions (Cold, Heat, Wet) - Not Required

Essential Job Duties

*Assist medical staff and hospital with proper nomenclature of medical terminology; proper coding and sequencing of ICD-9 and CPT codes. Interacts and provides feedback to physicians and clinical staff when documentation and/or coding issues arise in a timely manner.

*Performs coding audits concurrently and/or quarterly for surgical and non-surgical procedures in each of the offices to ensure coding compliance, sequencing and quality of work

*Reviews reports and codes all surgical procedures for all physician practices. Stays abreast of all coding and regulatory changes that would impact each of the physician practices

*Responds to any job-related issues presented by the coders and maintains proper communications with the staff.

*Oversees all physician reports related to physician coding and provide feedback and action plan. Assists and re-trains physicians, non-physician practitioners and office staff on coding guidelines as it pertains to their specific services performed

*Conducts meetings with each physician group to update and refresh on rules and regulations as it pertains to the practice

*Serves as the coding liaison between physicians and billing companies. Validates coding of billing performed by billing companies

*Validates charges for services performed by physician and non-physician practitioners (i.e. physician assistants, ARNPs).

*Validate data and monitor coding trends with the use of reporting sources (i.e. Business Intelligence).

*Communicates with physician practice services when there are missed opportunities

*Uses PEDS and CareCloud to review, code and abstract medical records.


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Miami Children's Hospital