Manager Medical Group Coding Quality

2 weeks ago

Evesham, United States VIRTUA Full time
Job Summary :

Responsible for clinical reimbursement quality by ensuring that Virtua Medical Group's coded data reflects the clinical information documented by clinicians. Responsible for management and implementation of coding quality and audits, education and training, standards development, etc. for CPT, ICD-10-CM, and HCPCS. Responsible for managing the annual external clinician audit process (medical staff and advanced medical providers), including re-audits, and education. Responsible for developing, implementing, and maintaining policies and compliance plan for physician coding and abstracting. Responsible for human resource management for audit team.

Position Responsibilities:

Internal Coding Quality Audits: Designs audit tools to monitor coding and abstracting quality and compliance; performs audits; provides timely feedback to staff, management, and physicians; implements improvement measures. Manages and performs special audits to facilitate quality improvements and compliance.

Annual External Coding Audit: Ensures all clinicians are audited by an external vendor on an annual basis, coordinates coding education for all clinicians, and manages clinician re-audit process.

Serves as a subject matter expert for daily professional fee coding inquiries. Works with various stakeholders on answers to questions regarding application of coding guidelines for individual accounts. Provides feedback in form of emails, calls, one on one meetings, group meetings, and presentations. Responsible to stay abreast of all coding changes and updates. Manages communication and training of those changes.

Designs education for staff and clinicians in correlation with audit findings, using best practice coding methods.

Human Resource Management: Interviews, hires, coaches, counsels, disciplines, terminates, evaluates, recognizes, and mentors VMG Auditors & Educators. Performs and approves payroll function/process. Monitors and reports on productivity and quality standards.

Policies and Procedures: Develops policies and procedures on coding, data abstraction, and audit standards. Documents and enforces policies and procedures for VMG and provides feedback to appropriate leaders and/or staff. Recommends changes to policies, procedures, and documentation requirements to ensure appropriate reimbursement.

Position Qualifications Required :

Required Experience:

Expert knowledge of professional fee coding required (ICD-10, CPT, HCPCS, and other reimbursement methodologies), including compliance and audit requirements.

2 years of supervisory experience preferred or 5-7 yrs of combined professional fee coding and auditing experience.

Excellent organizational, communication, and customer service skills.

Ability to utilize Information Systems, including electronic health records, effectively

Ability to make sound decisions independently and provide guidance to others.

Epic experience preferred.

Required Education:

Bachelor's or Associate's degree in Health Information Management/other related field, and/or 5-7 years of professional fee coding and auditing experience.

Training / Certification / Licensure:

Certification as a CPC and/or CCS-P required.

Certification as a CPMA preferred.

Virtua welcomes all individuals, inclusive of race, sex, sexual orientation, gender identity, religion and faith, national origin, and disabilities, and we proudly look to each person's unique achievements and experiences to continue to set us apart. Our whole-hearted commitment to an inclusive, diverse, and equitable workplace enables Virtua to be here for our communities, here for our patients, here for our colleagues-Here for Good.Learn More

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