Lead Clinical Data Specialist

This is a fully remote position, open to applicants in New York.

📋 Description

• Evaluate both inpatient and outpatient encounters, ensuring the accurate assignment of ICD-10-CM and CPT-4 codes.

• Examine medical records, including diagnoses, procedures, complications, and treatment specifics to gather comprehensive and appropriately detailed clinical data.

• Detect and amend erroneous codes to ensure medical and legal precision, as well as for regulatory reporting, reimbursement, research, planning, and statistical purposes.

• Analyze coding discrepancies, inaccuracies, omissions, billing rejections, and denials, providing necessary documentation and follow-up actions.

• Collaborate with HIM leadership, medical professionals, Revenue Integrity, Patient Billing, and Radiology leadership to address documentation and coding challenges.

• Lead, train, and mentor Clinical Data Specialists; assess their work and clarify coding rationales.

• Act as the primary administrator for CodeAssist; engage with 3M CEE, submit technical inquiries, and assist with system testing, coding-rule modifications, and connectivity issues.

• Work alongside Nuclear Medicine, General Radiology, Interventional Radiology, and Breast modalities to enhance coding and documentation practices.

• Contribute to special initiatives, including charge master upkeep, charge mapping, fee coordination, coding revisions, rejection rectification, and year-end code updates.

⛳️ Requirements

• A high school diploma or GED is mandatory.

• Four to seven years of professional coding experience is essential.

• A current certified coding credential is required, such as CPC, CCS, or CCS-P.

• In-depth knowledge of ICD-10-CM and CPT-4 coding standards is necessary.

• Experience in reviewing inpatient and outpatient encounters, Radiology medical records, billing rejections, coding edits, and clinical documentation is preferred.

• Proficient in utilizing coding, clinical, billing, and reporting systems, including Excel.

• Familiarity with Epic, HIS, CodeAssist, or similar platforms is highly advantageous.

• Capable of interpreting complex clinical information and delivering precise, compliant coding.

• Ability to guide coders through constructive reviews, practical training, and clear explanations of coding choices.

• Adept at investigating root causes and suggesting systematic improvements.

• Competent in meeting established quality and productivity benchmarks while ensuring accurate reporting.

🏝️ Benefits

• Comprehensive health insurance plans.

• Opportunities for professional development and continuing education.

• Generous paid time off and holiday leave.

• Retirement savings plans with employer matching.

• Flexible work arrangements and a supportive work environment.