Job Description

Department Summary

The Correctional Medicine Department is a non-academic service line under UNT Health Fort Worth's Clinical Practice Group. This Department oversees and manages two Comprehensive Medical Services contracts with Federal Bureau of Prisons (BOP) : Federal Medical Center (FMC) Fort Worth- male facility and FMC Carswell- female facility.

Position Overview

The major responsibilities of the Coding Team Lead shall include, but not be limited to, serving as lead coder for Business Operations to ensure accurate and timely pricing, medical record analysis, coding review, charge entry, and invoicing of contract services provided under UNTHSC’s Comprehensive Medical Services contracts with the Federal Bureau of Prisons (BOP) and other assigned departmental contracts and agreements.

Minimum Qualifications

Bachelor's degree or equivalent combination of education and experience, and three (3) years of coding experience. CPC or CCS-P coding certification required.

Knowledge, Skills and Abilities

In-depth knowledge of ICD-9-CM, ICD-10-CM, HCPCS, and CPT coding systems and guidelines, with the ability to apply them accurately across various patient records.
Solid understanding of federal and state healthcare regulations, including HIPAA, and the ability to ensure coding practices comply with these regulations.
Knowledge of EHR systems and their integration with coding processes, along with the ability to navigate and extract necessary data from EHR systems for accurate coding.
Understanding of the relationship between coding and billing, as well as payer-specific requirements, to ensure accurate reimbursement.
Strong ability to analyze clinical data and medical records to determine appropriate coding, ensuring both accuracy and efficiency.
Excellent attention to detail to ensure all diagnostic and procedural codes are accurately assigned, minimizing errors in data entry and claims processing.
Ability to lead and motivate a coding team, provide training and feedback, and foster a collaborative and productive work environment.
Strong organizational skills to manage multiple tasks and deadlines, with the ability to adapt quickly to changes in coding guidelines, system updates, and regulatory requirements.
Preferred Qualifications

Demonstrated experience in working with correctional health care service contracts.
Demonstrated capability in utilizing NextGen Enterprise Practice Management software application.
Required License/Registration/Certifications

Inpatient Coding Certification by the American Academy of Professional Coders (AAPC) or other accredited professional coding organization.

Job Duties

Serve as Team Lead principally responsible for reviewing inpatient, outpatient, long term care facility and provider claims submitted by Correctional Health Network facilities and providers under CMD contracts.
Review and validate accuracy and completeness of medical claims and assigned Diagnostic Related Group Rates (DRG) under Hospital Inpatient Prospective Payment System, Ambulatory Payment Classification (APC) under Outpatient Prospective Payment System, and Long-Term Care DRG under Long Term Care Hospital Prospective Payment System based on supporting documentation.
Assess all available patient medical records from multiple resources (electronic and hard copy) and verify medical coding to ensure accuracy of charges are consistent with the level of service, Medicare regulatory guidelines, and CMD contract terms and conditions. Evaluate appropriateness of assigned lCD 10, HCPCS and CPT codes, APC, DRG, LTCH-DRG, admission assignments and modifier usage.
Utilize NextGen Enterprise Practice Management (EPM) system to develop and maintain reporting tools for tracking and reconciling delinquent accounts and obtain needed and/or modified claims in a timely manner.
Develop action plans to address potential areas of process improvement and/or noncompliance. Create and provide education to Correctional Health Network facilities and providers based on claims review, when applicable.
Assist with developing and/or modifying new or existing policies and procedures based upon Medicare regulatory developments and compliance monitoring as well as auditing activities, processes and findings.
Physical Requirements

Sedentary work that primarily involves sitting/standing.
Communicating with others to exchange information.