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
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September 17, 2022
HealthEdge Software, Inc.
Columbia, South Carolina
FULL_TIME
Description
What the Role Involves (Responsibilities)
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
- 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
- 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.
- 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
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