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About the Role

The Senior Professional Coder will apply advanced professional coding skills to lead a service line coding team, supporting all workflows related to professional fee coding, charging, and denials follow-up. This role involves auditing CPT and ICD-10 coding for compliance, providing education to providers and staff, and acting as an expert for HCC/Risk Adjustment coding. The position is remote but requires occasional onsite education.

Responsibilities

Review, analyze, and validate CPT and ICD-10 diagnosis codes and charges for compliance with regulations and guidelines.
Ensure established productivity and quality standards are met.
Assist the Supervisor in daily operations of coding teams, ensuring staff meet productivity and quality standards.
Assume supervisory tasks for assigned coding staff in the absence of the Supervisor.
Perform accurate and compliant coding of CPT and ICD-10 diagnosis codes.
Define and submit coding/edit rules to streamline coding accuracy and efficiency.
Participate as a workflow expert in application testing, including test script building and charge import review.
Assist with the implementation, testing, troubleshooting, and maintenance of third-party vendor applications.
Assist in preparing, overseeing, and approving staff schedules.
Orient and train staff, provide feedback, and evaluate performance.
Assist in establishing department goals and ensuring their achievement using LEAN management skills.
Participate in the recruitment and interview process.
Perform System Manager tasks for specified applications in their absence, including report creation and charge import.
Assist in creating and updating policies, procedures, and system documentation.
Perform medical record chart reviews to ensure documentation and HCC diagnosis code selection meet CMS requirements.
Code chronic diseases meeting HCC and Risk Adjustment criteria and validate missed coding opportunities.
Conduct professional fee billing integrity reviews/audits, assessing compliance and identifying clinical documentation improvement opportunities.
Identify trends from audit findings and formulate recommendations for education and corrective actions.
Communicate audit results and assist in developing action plans.
Assist with Denials Management to identify root causes and provide feedback and training to reduce denials.
Act as a liaison for external audits and implement necessary changes based on findings.
Attend and contribute to staff and department meetings.
Fulfill department requirements for work coverage during personnel absences.
Assume responsibility for professional development through webinars, workshops, and conferences.
Work effectively with people from diverse disciplines and expertise levels.
Perform other duties as assigned.

Requirements

High School Diploma/G.E.D. required.
Two or more years of prior experience in professional fee coding required.
Working knowledge and experience with provider professional fee coding and charge processing.
Complex coding skill set required.
Computer experience in a Windows environment with proficiency in Microsoft Word and Excel is required.
Excellent verbal and written communication skills (High proficiency).
Equivalent combination of relevant education and experience may be substituted as appropriate.

Skills

CPT coding
ICD-10 diagnosis coding
HCC/Risk Adjustment coding
Microsoft Word
Microsoft Excel
LEAN management skills

Location

Remote
Onsite (for education as needed)

Work Type

Remote
Full-time

Experience Level

Senior
Two or more years of prior experience in professional fee coding

Education Level

High School Diploma/G.E.D.
CPC
CCA
CCS
COC
RHIT
RHIA

Salary/Compensations

$64,972.00 - $97,458.00

About the Company

Albany Medical Center is an equal opportunity employer.
Albany Med Health System is an equal opportunity employer.
This role may require access to information considered sensitive to Albany Medical Center, its patients, affiliates, and partners, including but not limited to HIPAA Protected Health Information and other information regulated by Federal and New York State statutes. Workforce members are expected to ensure that: Access to information is based on a “need to know” and is the minimum necessary to properly perform assigned duties. Use or disclosure shall not exceed the minimum amount of information needed to accomplish an intended purpose. Reasonable efforts, consistent with Albany Medical Center policies and standards, shall be made to ensure that information is adequately protected from unauthorized access and modification.

Equal Opportunity

Albany Medical Center is an equal opportunity employer.
Albany Med Health System is an equal opportunity employer.