Provides day-to-day leadership, subject matter expertise, and operational oversight to a team of coders supporting obstetrics/gynecology and behavioral health services.
Ensures accurate, compliant, and timely coding of professional services while supporting quality, productivity, staff development, and regulatory compliance across assigned specialties.
Reviews and validates professional coding for OB/GYN and behavioral health services prior to charge entry or approval.
Ensures accurate assignment of diagnosis and procedure codes, modifiers, and units in compliance with CMS, OIG, and payer guidelines.
Provides routine coding audits and quality reviews; provides targeted feedback and education based on findings.
Identifies documentation gaps, denial trends, and compliance risks and recommends corrective actions.
Appropriately queries providers for missing, conflicting, or unclear documentation.
Reviews and resolves coding-related claim rejections and denials.
Ensures all services meet medical necessity and documentation requirements prior to billing.

Active coding certification required (CPC, CCS, CCS-P, or equivalent).
Minimum of five (5) years of professional medical coding experience, in OB/GYN within a physician billing or revenue cycle environment.
Advanced knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines, including specialty-specific rules for OB/GYN.
Thorough knowledge of CMS, Medicaid, and commercial payer requirements, including fraud and abuse regulations.
Strong working knowledge of Electronic Health Records (EHR) and physician billing systems.
Full knowledge of HIPAA regulations and confidentiality standards.
Demonstrated leadership, coaching, and communication skills.

Lead Coder

Key skills