Health Business Solutions LLC

SENIOR CLINICAL CODING TEAM LEADER

Key Responsibilities:

• Lead and mentor clinical coding analysts, serving as the primary escalation point for complex, high‑risk, or high‑value coding and denial cases
• Provide functional leadership to ensure coding quality standards are consistently met across teams
• Support onboarding, knowledge transfer, and ramp‑up activities for new hires and expansion waves
• Partner with training and QA teams to identify skill gaps and drive targeted education initiatives
• Oversee analysis and validation of diagnosis (ICD‑10‑CM), procedure (CPT/HCPCS), and modifier usage across revenue cycle workflows
• Perform secondary reviews and audits to validate coding accuracy, sequencing, DRG/APC integrity, and documentation sufficiency
• Ensure alignment with CMS, AHIMA, AAPC, and commercial payer coding and reimbursement guidelines
• Establish and maintain audit‑ready, compliant coding practices
• Lead root cause analysis (RCA) initiatives for coding‑related denials, identifying systemic process, documentation, or training gaps
• Monitor effectiveness of corrective and preventive actions and report outcome improvements
• Provide leadership support for coding‑based appeals, including clinical validation and medical necessity disputes
• Conduct regular audit and review of coded medical records, ensuring accuracy, completeness, and compliance with relevant coding guidelines, industry standards, and regulations to support appeals narratives and rebuttals
• Ensure alignment with client‑specific workflows, KPIs, SLAs, and escalation protocols
• Stay up to date with the latest changes in coding guidelines, regulations, and industry best practices, and ensure timely implementation of necessary updates within the organization. 
• Provide guidance and mentorship to coding staff, assist in the resolution of complex coding cases, and promote professional development. 
• Generate regular reports and metrics related to coding quality, productivity, and compliance, highlighting areas of concern and recommending actionable improvements. 
• Collaborate with IT teams and other stakeholders to optimize coding tools, software, and systems, ensuring seamless integration within the revenue cycle processes. 
• Participate in coding-related projects, committees, and cross-functional teams, representing the coding and revenue cycle perspective and contributing to organizational goals. 

• Qualifications:
• Certifications: Certified Professional Coder (CPC), Certified Coding Specialist (CCS), Certified Inpatient Coder (CIC), or similar certification is required.
• Experience: Minimum of 3-4 years of medical coding or auditing experience and experience with risk adjustment audits, clinical documentation improvement (CDI), and payer audits.
• Knowledge of Coding Systems: Strong knowledge of ICD-10, CPT, and HCPCS coding systems, and familiarity with DRG, E/M coding.
• Bachelor's degree: in Nursing, or any Medical or Health Information Management or a related field.
• Proficient in using coding software, encoders, and electronic health record (EHR) systems. 
• Excellent understanding of revenue cycle workflows, including charge capture, billing, claims processing, denials, and reimbursement methodologies. 
• Proven track record in conducting coding audits, implementing quality coding improvement initiatives, and achieving measurable outcomes. 
• Exceptional attention to detail and accuracy, coupled with excellent organizational and problem-solving skills. 
• Effective communication and interpersonal skills, with the ability to collaborate with diverse stakeholders, provide education, and resolve coding-related issues. 
• Ability to work independently, prioritize tasks, and meet deadlines in a dynamic and fast-paced environment. 
• Proficiency in using coding-related software and tools, as well as a high level of computer literacy. 

• Prior experience in a team lead or senior SME role is preferred.