Health Information Management
1 month ago
Job Title: Coding Manager
Location: San Diego, CA 92173 (Hybrid, minimum weekly onsite)
Schedule: Monday – Friday 8am – 5pm
Duration: Direct Hire
Position Summary:
Responsible for developing, implementing, and maintaining risk adjustment functions.
and processes for San Diego PACE, leading a team of coding auditors, and facilitating.
the improvement in overall quality, compliance, completeness, appropriateness, and
accuracy of documentation and coding for professional services.
While reporting to the San Diego PACE Finance Director, will work collaboratively with
operations and clinical leadership to improve coding and documentation performance.
Responsibilities:
Responsible for developing, implementing, and maintaining risk adjustment functions and processes for San Diego PACE to facilitate improvement in overall quality, completeness, appropriateness, and specificity of documentation.
2. Hire, lead, train, and oversee a successful team of coding auditors and manage
their performance to create a cohesive and highly effective team.
3. Contribute actively to new clinical program development through creation of
training tools, resources, procedures, and workflows for providers and San Diego
PACE coding auditors.
4. Educate, train, onboard, and communicate effectively with the team of providers
on accurate, complete, and compliant documentation and coding practices and
hold regular and episodic provider training initiatives.
5. Assess current compliance activities and evaluate risk factors in coding and
documentation practices and implement strategies to mitigate risk by educating
providers and coders.
6. Responsible for timely review of all billable encounters prior to claims submission
for accuracy and completeness and comprehensive concurrent coding reviews
and audits of a subset of encounters, with emphasis on documentation quality,
accuracy, completeness, compliance, and specificity.
7. Establish, implement, and maintain a formalized review process for coding and
documentation compliance, including a formal audit process and quality control.
8. Communicate with the providers in real time prior to claims submission or redaction
through coding queries regarding need for clarification, amendment, or
modification of specific patient encounters, following compliant practices to
optimize documentation accuracy, specificity, and completeness.
9. Work with the provider team and center operations on timely closure of encounters
and completion of tasks related to documentation and coding practices.
10.Oversee successful and timely bi-annual creation of redaction and submission
Risk Adjustment Processing System (RAPS) files to the Center of Medicare and
Medicaid Servicer (CMS).
11.Contribute to successful transitions of vendors, including Electronic Health
Records, to minimize potential burden and vulnerabilities, and improve clarity of
expectations pertinent to documentation and coding practices, including
development, training, and implementation of new workflows and processes for
the impacted teams.
12.Meet with external vendors and internal resources and stakeholders monthly to
review coding analytics dashboards and reports, gain a deep understanding of
current and past performance, identify trends, opportunities, and future strategies,
and communicate those with the San Diego PACE leadership team and ensure
necessary actions are taken by appropriate teams and individuals to address gaps
in performance.
13.Stay current with Official Coding and Reporting Guidelines, CMS and other agency
directives for ICD-10-CM/PCS and CPT coding and serve as a Subject Matter
Expert to collaborate and communicate existing and new guidelines with other
departments, such as medical practice, operations, and finance.
14.Routinely reevaluate existing workflows to identify opportunities for improvements,
standardization, or re-education to increase efficiency and accuracy of
documentation and coding for all services and providers.
15.Serve as a resource to bridge the gaps between the clinical providers and coders
and facilitate resolution of documentation and coding issues.
16.Provide timely feedback to the coders and auditors and take corrective action to
ensure highly effective practices.
17.In collaboration with Coders and PACE Finance Director, periodically reviews
reimbursement trends by Hierarchical Condition Category (HCC) codes to
evaluate opportunities and identify payment issues, making recommendations for
changes, as necessary.
18.Proficient with ICD-10 and CPT coding as well as E&M and all professional coding
guidelines for large multi-specialty provider groups
Additional Duties and Responsibilities:
1. Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars.
2. Provide direction, management, and supervision to ensure efficient operation of assigned departments.
3. Coordinate with Other PACE departments to develop standardized processes and gain system-wide efficiencies.
4. Function as a cross-functional collaborator, build trust, and communicate effectively with central and site-specific leadership, stakeholders, and providers throughout the organization.
Qualifications:
EDUCATION
(Minimum level of education Preferred): Bachelor’s degree in health information management, Health Care Administration, Business Administration or equivalent combination of education and training.
Experience (Minimum level of experience):
- 5 years of healthcare experience required; at least 3 years of management experience preferred.
- 3 to 5 years of hands-on professional coding experience in large multi-specialty group - 2+ years of experience as a trainer / educator to physicians and coders
- Bachelor’s degree in health information management, Health Care Administration,
Business Administration or equivalent combination of education and training.
Certifications/Licenses Required:
CERTIFICATIONS/LICENSES REQUIRED:
- CA driver’s license with appropriate insurance coverage
- Active and current Certified Procedural Coder accreditation by an accredited organization or college, such as the AAPC, that meet the state licensure requirements, you will be required to maintain coding accreditation
Verbal and Written Skills Required to perform the Job:
- Good written and verbal communication.
- Strong communication and presentation skills, preferably comfortable speaking with
people at an executive level or physician level
Working Traits:
- Superb organizational ability and exceptionally analytical.
- Technical Knowledge and Skills Required to Perform the Job:
- Experience and knowledge with Microsoft Office software.
Equipment Used:
Company’s Laptop, occasionally personal phone.
Working Conditions and Physical Requirements:
Long Irregular hours.
May work weekends.
Prolonged periods of sitting, and constant walking and standing.
Driving and occasional travel required.
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