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Manager Health Information Management PB Coding
3 months ago
Summary:
The CHRISTUS Health Coding Manager is considered a Physician-Based (PB) system support position that provides leadership, support, and direction, for the Director of Coding Operations and the PB coding staff.
Coding Managers work collaboratively with system Revenue Cycle, the PB Education and Audit team, the facility Health Information and Records Services departments, Patient Access Teams, Patient Financial Services, Physicians, hospital leadership and management.
The Coding Manager is responsible for supporting compliance with CHRISTUS standards and directives, the American Academy of Professional Coders (AAPC), the American Health Information Management (AHIMA), American Medical Association (AMA), and Current Procedural Terminology (CPT) coding rules and guidelines, and other regulatory requirements including Centers for Medicare and Medicaid Services (CMS), NCCI, Office of Inspector General (OIG), and HIPAA standards related to clinic operations.
As a manager, this position ensures that Coding operations are standardized, meet regulatory requirements, and support optimal department performance to support Trinity Clinic operations and revenue cycle initiatives.
This position performs timely monitoring and analysis of clinic coding operations to ensure performance objectives are met to support quantity and quality standards.
This position is expected to maintain effective professional relationships as appropriate to instruct, share ideas, and implement actions related to coding functions and improvements.
This position monitors and reports KPIs as determined by the Director of PB Coding Operations.The position has direct oversight and accountability for the management of WQs, workload balance, staff timekeeping, staff development, mentoring, and quality assurance.
The Manager has overall responsibility for all staff within the assigned unit and directly supervises the department leads and staff within that unit.
The Manager is responsible for ensuring that each team member within the assigned unit is effectively, efficiently, and accurately conducting all aspects of tasks assigned.
The Manager provides leadership and direction so that productivity and quality expectations are consistently measured and achieved, backlogs are avoided and promotes and supports a culture of continuous learning throughout the department.
Responsibilities:
Ensure records are coded accurately using current CPT, HCPCS, ICD-10-CM Guidelines, Compliance Department policy, and other corporate requirements. Selects, coaches, motivates, conducts performance evaluations, and directs the workflow for staff assigned to coding function. Manages staff timekeeping, PTO requests, and unscheduled absences.
Develops goals and performance expectations for staff in targeted areas, such as unbilled accounts receivable, quality and timeliness of clinical coding assignments, data integrity and reimbursement with third party payers.
Provides for the education, development, and shared leadership of staff.Assists in setting and maintaining budgetary department goals for the coding area. Monitors overtime to help achieve budget goals.
Participate in organization performance improvements by creating and monitoring the coding scorecard which includes coding productivity; coding accuracy; WQ backlog, etc.
Monitors goals, productivity, and quality standards in conjunction with industry trends and CTC needs. Participates in developing standard coding policies/procedures/guidelines to ensure compliance with federal, state. and local regulatory guidelines to minimize risk for the organization.Supports coding infrastructure to ensure regulatory compliance in all aspects of coding and abstracting of clinical data to support patient care processes.
Set expectations and allocate work utilizing KPIs to drive productivity and efficiency.Provide technical support to medical providers and coding/billing specialists as appropriate regarding coding compliance documentation, regulatory provisions, and third-party payer requirements.
Research root causes and initiate claims resolution in the billing system with knowledge of the upstream and downstream impact of work.
Leverage functionality of Epic to increase clean claim rate, reduce denial rates and increase cash collections, through implementation of claim rules and edits.
Directly communicate with physicians and practice managers on areas of opportunity.Monitor WQs to maintain grasp on coding backlogs, and proactively shift coders to areas needing additional support. Counsel employees in performance improvement, conflict resolution, disciplinary action, and coordination of employee schedules for adequate coverage.
Works with departmental appeals staff to identify trends and develop solutions.
Works in conjunction with the PB Education Department and Compliance to ensure that educational programs are appropriately developed and delivered.
Assists with evaluation of new clinics and services by researching appropriate coding/billing and payer coverage policies as well as staffing needs.
Holds regularly scheduled staff meetings and makes minutes available to staff and Director.Maintains effective communication with physician offices to ensure smooth and efficient department operations, advising director as necessary to expedite resolution of any problems.
Assumes responsibility for personal and professional development to ensure current knowledge in the profession/position.Supervise external vendors who provide coding services to ensure accuracy and compliance.
Ensure coding staff maintains a high quality and productivity standard, per department benchmarks. Disseminates changes in coding rules such as correct coding initiative (NCCI), AMA, CPT Assistant and Coding Clinic. Monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement, and coding to assure compliance. Promote morale by effectively communicating goals, standards and needs of the department and organization.
Foster an environment of teamwork and service excellence within the department.
Provide leadership for process improvement and redesign to improve customer satisfaction, reduce costs, and/or meet departmental and institutional goals and objectives.
Work and communicate with all departments, coding professionals, and medical staff to improve documentation in the medical record.Facilitate cross training opportunities for coders. Interview, assess and hire new coding associates.
Ensure compliance with the OIG, CMS, commercial payer policies, and plays a key role in denials management involving coding related issues.
Perform other duties as assigned.Requirements:
Bachelor's degree, medical record science or medical record administration preferred, or equivalent physician practice leadership experience required. Subject matter expert in Evaluation and Management, CPT coding guidelines and required documentation. Strong knowledge in ICD-10 CM, CMS/NCCI, Modifiers and HCC coding.
Extensive knowledge of NCDs / LCDs and how to successfully navigate updates to decrease impact to claim processes.
Strong working knowledge of payer denials and policies.
Strong knowledge of payer and clearinghouse claim edits and rules.
Strong presentation skills, with ability to effectively communicate to Executive and Physician leadership teams on KPIs and strategic priorities.
Excellent relationship building skills and aptitude for working collaboratively with cross-functional groups.
Able to independently manage multiple tasks and deadlines, with minimal oversight.
Able to clearly document processes and facilitate process to external users.
Demonstrated attention to detail required.
Critical thinker with ability to problem solve, perform root-cause analysis, and implement action plans.
Must possess a strong working knowledge in internal integrity requirements and procedures.
Knowledge of governmental, federal, state, and local regulations related to billing rules and compliance.
Must possess strong analytical skills.
Excellent oral and written communication skills required.
Must have strong knowledge of common office software applications including Power Point, Excel, Word, etc.
Minimum of five (5) years' experience in a physician-based coding department of a large group or a mid-large healthcare system, including two (2) years in either a Coding Lead or Coding Manager capacityExperience with remote work force operations requiredCertified Professional Coder (CPC), preferred Certified Coding Specialist - Physician-based (CCS-P), preferredRegistered Health Information Administrator (RHIA)
Work Type:
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