Coding Manager Quality Risk

3 weeks ago

Tampa FL, United States TotalMed Full time
This function provides coding and coding auditing services directly to providers. This includes the analysis and translation of medical and clinical diagnoses, procedures, injuries, or illnesses into designated numerical codes. Demonstrates experience by correlating coding accuracy with correct HCC assignment for MA/Risk and/or CPT, ICD-10, HCPCS and Modifiers for FFS. Complies with all aspects of Coding and Corporate Compliance standards. Abides by all ethical standards and adheres to official coding guidelines.

*ESSENTIAL FUNCTIONS:*

· Develops overarching strategies for the analytical and specialized coding processes for the department.

· Sets the fundamental direction of executing these strategic plans with the team.

· Manages, guides, and supports the overall work of the team to maximize results by providing subject matter expertise and training.

· Oversees work activities of others (e.g., staff, team leads, supervisors) and is the point of contact for escalated coding related matters and concerns.

· Adapts departmental plans and priorities to address business needs and operational challenges.

· Gathers relevant data and analyzes information to resolve complex billing/coding issues and determine the root cause for coding discrepancies.

· Reconcile discrepancies identified on coding correction and held voucher reports.

· Generate and/or distribute reports and documentation to leadership team and/or ancillary departments.

·Demonstrate understanding of relevant systems and coding software applications (e.g. Practice Management Systems, EMRs, MS Office, Medical Coding software)

·Leverage understanding of disease process to identify and extract relevant details and data within clinical documentation and make determinations or identify appropriate medical codes.

·Utilize resources and reference materials (e.g., on-line sources, manuals) to identify appropriate medical codes and reference code applicability, rules, and guidelines

·Apply understanding of relevant medical coding subject areas (e.g., diagnosis, procedural, evaluation and management, ancillary services) to assign appropriate medical codes

·Apply understanding of basic anatomy and physiology to interpret clinical documentation and identify applicable medical codes

·Identify areas in clinical documentation that are unclear or incomplete and generate queries to obtain additional information.

·Follow up with providers as necessary when responses to queries are not provided in a timely basis

·Read and interpret medical coding rules and guidelines to make decisions (e.g., exclusions, sequencing, inclusions)

·Responsible for maintaining current knowledge of coding guidelines and relevant federal regulations through the use of current HCC and/or CPT-4, HCPCS II, and ICD-10 materials, the Federal Register, and other pertinent materials.

·All other duties assigned

*EDUCATION:*

·Undergraduate degree or equivalent experience.

·AAPC or AHIMA approved coding certification program.

·CPC, CRC or RHIT certification

*EXPERIENCE:*

·Must have 3-5 years of coding experience in a Primary Care/Specialty environment.

·3+ years of Management experience

#INDMLK

Job Type: Full-time

Pay: $54.00 per hour

Benefits:
* 401(k)
* Dental insurance
* Health insurance
* Life insurance
* Vision insurance
Schedule:
* 8 hour shift
* Day shift
* Monday to Friday

Work Location: In person

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