编码负责人
Lead Coding Specialist
Lead HIM Coder 协助通过培训员工和监控所有编码功能及工作队列来管理编码团队。他们审核记录以提高团队内编码和收费的准确性与质量。作为与 CDI 和医生的联络人，以提升文档质量、优化报销并支持高效的 AR 表现。
主要职责：
• 管理多个 EPIC 工作队列（WQs），确保在 2-3 天内及时完成所有就诊的计费和解决。
• 监控并审核编码员表现，通过定期审查、会议和反馈环节确保编码和 DRG 准确率 >= 95%。
• 培训和指导编码人员，为新编码员提供入职培训，进行日常指导，并每月召开团队会议以保持准确性和合规性。
• 作为编码部、CDI 计划、医生和收入完整性之间的联络人，以提升文档质量、查询流程和收费准确性。
• 进行每日编码审核，并审查所有 PSI、Vizient 和 3M 数据，以验证编码准确性、病例质量和绩效指标。
• 监督 DRG 验证和拒付管理项目，解决编码争议并确保文档支持准确的报销。
• 应用国家编码标准和指标，保持对 SOI/ROM、AHRQ PSI 标准、NTAP 案例和 Medicare 报销系统的专业知识。
• 跟踪行业更新，包括 Medicare PPS 变化、编码诊所指南以及 SDOH 和 COVID 相关编码等新兴趋势。
• 推动流程改进计划，与 CDI、质量及急诊部门领导合作，提升文档质量，减少拒付并提高国家质量评级。
• 在需要时执行编码任务，支持工作量平衡，减少未出院即未计费（DNB）案例，并达成月度绩效目标
最初发布于 Himalayas
查看英文原文
A Lead HIM Coder assists in managing the coding team by educating staff and monitoring all coding functions and w ork queues. They audit records to improve the accuracy and quality of coding and charging within the team. Serves as a liaison with CDI and physicians to enhance documentation, optimize reimbursement, and support efficient AR performance.
Principal Accountabilities:
• Manages multiple EPIC work queues (WQs) to ensure timely billing and resolution of all encounters within 2–3 days.
• Monitors and audits coder performance, ensuring >/= 95% coding and DRG accuracy through regular reviews, meetings, and feedback sessions.
• Educates and mentors coding staff, providing onboarding for new coders, daily coaching, and monthly team meetings to maintain accuracy and compliance.
• Acts as a liaison between the Coding Division, CDI Program, physicians, and Revenue Integrity to improve documentation, query processes, and charge accuracy.
• Conducts daily coding audits and reviews all PSI, Vizient, and 3M data to validate coding accuracy, case quality, and performance metrics.
• Oversees the DRG validation and denial management program, resolving coding disputes and ensuring documentation supports accurate reimbursement.
• Applies national coding standards and metrics, maintaining expertise in SOI/ROM, AHRQ PSI criteria, NTAP cases, and Medicare reimbursement systems.
• Stays current on industry updates, including Medicare PPS changes, Coding Clinic guidance, and emerging trends such as SDOH and C OVID-related coding.
• Drives process improvement initiatives, collaborating with CDI, Quality, and ER leaders to enhance documentation, reduce denials, and improve national quality ratings.
• Performs coding duties as needed, supporting workload balance, reducing discharged-not-billed (DNB) cases, and meeting monthly performance goals
Originally posted on Himalayas