Director, Medical Coding and Reconciliation

1 month ago

Valley Park, Missouri, United States RAYUS Radiology Full time

RAYUS Radiology, formerly Center for Diagnostic Imaging and Insight Imaging, is looking for a Director, RCM Coding Process and Compliance to join our team. We are challenging the status quo by shining the light on radiology and making it a critical first step in diagnosis and proper treatment. Come join us and shine brighter together.

As a Director, RCM Coding Process and Compliance, you will manage and supervise the charge and personnel and workflow; monitor and ensure process integrity; complete general Revenue Cycle Management leadership responsibilities. This position is full-time, Monday - Friday.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

(55%) RCM Leadership

  • Ensures that the company is billing compliantly, at all sites, according to HCFA regulations which includes using accurate and appropriate CPT, HCPCS, and ICD-9 codes and only billing for those services actually ordered, performed, completed and documented
  • Leads business-related center procedure changes and expansion
  • Leads the Coding Quality Program implementation, including regular monitoring, reporting and process improvement
  • Provides direction on special coding initiatives, including coding compliance, internal audit and training and education for the staff
  • Reviews coding literature, attends coding seminars, and disburses new or updated coding information to those involved (i.e. Radiologists, Business Office staff, Front Desk staff, etc.)
  • Works with outside sources to ensure compliance regarding day-to-day operations, policies and procedures and the quality (coding auditing) program
  • Responsible for setting up and documenting policy and procedures for new study cases and outside read contracts within the RIS and billing system
  • Maintains appropriate documentation concerning billing policies and procedures
  • Communicates and trains with center management and physicians regarding appropriate documentation for studies as well as education on medical necessity
  • Maintains quality checks and balances to ensure that processes are in place and being followed to protect the integrity of charges being posted to patient accounts
  • Responsible for ensuring that all coding changes are implemented and updated on fee schedules as well as the RIS
  • Works with the payor contract analysts to identify areas were adjustments need to be made to fee schedules
  • Works with other Business Office management on high volume denial issues and assists in working with the associates and/or payors for resolution
  • Facilitates RCM process improvement initiatives within the markets
  • Works with the VP's or medical director to establish, update, and implement fee schedules in all markets and help the Company remain price competitive
  • Ensures that all yearly radiology coding additions/deletions/changes are updated in the RIS and Practice Management System
  • Responsible for ensuring the billing export is functioning appropriately and is accurately transferring data into the Practice Management System
  • Participates with and is a member of the Corporate Compliance Committee

(20%) Database Administration

  • Maintains the RIS and billing system chargemaster including fee schedule administration, reviews fee schedules for competitive pricing, and working with the radiologists and/or Center Managers to develop fee schedules for new procedures and self-pay pricing
  • Creates database set-up and administration of exams, codes, and fee in the RIS database, including involvement with the set-up and administration of the electronic interface between the RIS and billing system.
  • Trouble-shoots IS-related issues within the Business Office

(20%) Staff Management

  • Initiates and participates in staff performance evaluations, compensation and development of associates including performance improvement plans, disciplinary actions and/or termination of associates
  • Participates in the hiring and training of new associates
  • Leads regular staff meetings and employee one-on-ones
  • Manage off-site coding teams (Buffalo) and off-site coders (Texas/New York) in conjunction with the Charge and Coding Supervisor
  • Integrates new centers into current processes, which includes training and working with the center's staff and radiologists

(5%) Completes other tasks and projects as requested

Required:

  • Bachelor's degree
  • 5 years medical business office experience required including extensive knowledge of CPT, HCPCS and ICD-9 coding
  • 5 years supervisory experience
  • Radiology coding experience
  • 2-3 years Microsoft Office Suite experience
  • Valid driver's license and proof of current insurance

RAYUS is committed to delivering clinical excellence in communities across the U.S., driven by our passion for and superior service to referring providers and patients. RAYUS Radiology is built on our brilliant medicine, brilliant team, brilliant technology and services - all to provide the highest level of patient care possible.

We bring brilliance to health and wellness. Join our team and shine the light on Radiology Services

RAYUS Radiology is an EO Employer/Vets/Disabled.

Rayus is an equal opportunity employer; applicants are considered without discrimination with regard to race, color, religion, sex, national origin, age, disability, veteran status or other statuses protected by state, local or other applicable laws. This policy extends to all aspects of employment, including recruitment and hiring.

Rayus and its associates have an employment relationship, which is known as employment-at-will. This means that either Rayus or an associate has the right to terminate the employment relationship at any time, for any reason with or without cause or prior notice.

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