Team Lead, Clinical Coder

HealthEdge Software, Inc. Columbia, South Carolina
team lead team develops data big picture people coach medical qa software commercial contracting foster
September 17, 2022
HealthEdge Software, Inc.
Columbia, South Carolina
FULL_TIME
Description

What the Role Involves (Responsibilities)
  • Helps to train and coach team members
  • Continually assesses and evaluates clinical edit compliance with CMS, Medicaid, and industry standards
  • Reads and analyzes medical policy including final rulings, daily transmittals, bulletins, policy manual updates and more to begin the cycle of product development/maintenance
  • Analyzes, reviews, studies, and verifies data as it becomes available from government and other policy agencies. This can be a 1,200 page provider manual or revisiting a physician fee schedule (data file) that has been reposted
  • Contacts various entities to clarify new and existing policy
  • Develops formal clinical edit criteria within system payment rules and develops clinical policy billing rules
  • Acts as a clinical liaison and subject matter expert with internal staff and clients
  • Engages existing clients to identify specific functionality requirements
  • Suggests and presents claim edits to clients for selection
  • Coordinates with developers, QA, and client service team members to ensure that clinical edits are implemented accurately and timely
  • Writes requirements
  • Develops test claims for UAT and QA
  • Develops and maintains a high level of proficiency in the Companys products (software, data) and services (advisory, analytic, training/education), including commercial contracting features as related to the specific area(s) assigned
  • Develops and delivers internal and external educational presentations related to Medicare/Medicaid reimbursement or commercial contracting features
What Youve Got (Qualifications & Skills)
  • Bachelors Degree or above (equivalent work experience considered)
  • 5+ years professional experience in a fast-paced health care environment
  • 1 or years in a supervisory capacity
  • Extensive background of ICD-9 and CPT coding principles
  • Extensive knowledge of medical claim editing (NCCI, etc.)
  • Knowledge of industry standard payment rules and methods
  • Recognized prior expertise in claims processing, payment policy, or contracting
  • Facility in using MS Office (Word, Excel, PowerPoint, Access) software applications
  • Facility in using various Web-based and other research sources and tools
  • AHIMA, AAPC or other nationally recognized coding certification Certified Professional Coder (CPC) or Certified Coding Specialist (CCS) certification , preferred
  • Excellent Communication Skills
  • Self-motivated with the ability to work independently and in a team environment
  • Critical (analytic) thinking, looking into logic-based details while problem-solving for the overall big picture
  • Professional poise: ability to credibly interact with and educate various internal and external groups and individuals (colleagues, clients, industry groups), effectively navigating organizational environments and managing expectations
  • Ability to foster professional and personal respect and collaboration
  • Team building and people development and management skills
Who You Are (Ideal Competencies/Skills)
  • Creative entrepreneur. You have a constant drive to make things better; you question the status quo and approach common challenges with creativity and constructive criticism. You have skills to share ideas clearly and convincingly in a way that adapts to your audience, regardless of function, level, or expertise.
  • Critical, big-picture thinker . You have a constant thirst for knowledge and the ability to credibly share it with others, whether internally or externally. You are analytical, evaluating logic-based details while always considering and problem-solving for the sake of the big picture.
  • Self-starter. You are proactive, self-motivated, and able to push work, start initiatives, and provide ideas independently in a team environment.
  • Team player & coach. You can foster professional and personal respect from others and find success in a team setting. While highly collaborative, you have natural management skills and know how to grow and develop people.
  • Adaptable multi-tasker. You are highly organized and flexible. You know how to manage expectations and are able to thrive in fast-paced, constantly changing environments and successfully adapt to a variety of tasks.
How We Work (Team & Culture)
  • Collaborative . We work together and help each other do our best by building on our work across teams and offices. We do not own individual ideas or seek credit.
  • User-driven. We place our clients and our users needs above all else. If it matters to a user, it matters to us. We work for them and keep ourselves accountable to that.
  • Hands-on . We do not wait for problems to solve themselves. We enter the thick of it and get things done.
  • Impact over ego. Our culture is about results, not ownership. Great ideas have seniority over titles and levels, and great thinkers outshine fancy pedigrees.
  • Forward-looking . We look beyond our own world to constantly improve our business. We welcome outside speakers, tap into the latest tech, and make sure were future-proof in anticipation of whats coming next.
  • Caring & close knit. We know and care about our people. We know each others project strengthsbut also about upcoming family trips and favorite after-work drinks
HealthEdge provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.


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