Manager Coding Quality Risk
3 weeks ago
OVERVIEW OF POSITION:
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.
- Make determinations on medical charting and take initiative to complete reviews independently to avoid delays in the process
- Manage multiple work demands simultaneously to maintain relevant productivity and turnaround time standards for completing medical records (e.g., charts, assessments, visits, encounters)
- Resolve medical coding edits or denials in relation to code assignment
- Perform medical coding audits to evaluate medical coding quality and review results
- Provide information or respond to questions from medical coding quality audits and utilize results to identify potential corrections/enhancements to the coding processes.
- Follow steps per agreement with medical coding audit results to resolve discrepancies
- Provide resources and information to substantiate medical coding audit findings
- Educate and mentor others to improve medical coding quality
- Apply understanding of National Correct Coding Edits to the coding process
- Demonstrate understanding of National and Local coverage determinations
- Demonstrate basic knowledge of the impact of coding decisions on revenue cycle
- Demonstrate understanding of relevant terminology required for coding
- Follow relevant professional code of ethics consistent with required certifications
- Attain and/or maintain relevant professional certifications and continuing education seminars as required
- Uses, protects, and discloses patients' protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards.
- Ability to travel may be required.
EDUCATION:
- Undergraduate degree or equivalent experience.
- AAPC or AHIMA approved coding certification program.
- CPC, CRC or RHIT certification
EXPERIENCE:
Minimum:
- Must have 3-5 years of coding experience in a Primary Care/Specialty environment.
- 3+ years of Management experience
Preferred:
- Primary Care Physician coding experience
- Risk Adjustment/HCC coding experience
- Knowledge of Fee for Service, Medicare, Medicare Advantage, and Health Maintenance Organization (HMO) payer guidelines
- Experience working within an EMR
KNOWLEDGE, SKILLS, ABILITIES:
- Ability to oversee the daily responsibilities of the Coding department, while setting goals and priorities for the team.
- Must have an excellent understanding of medical terminology, disease process and anatomy and physiology.
- Must have an excellent understanding of ICD-10-CM coding classification and guidelines.
- Must have an excellent understanding of CPT, HCPCS and Modifiers coding and guidelines within a primary care environment.
- Must have Computer skills (i.e. MS Office, Power Point).
- Must have good organizational and communication skills.
- Must be task oriented and able to meet designated deadlines and productivity standards.
- Must have strong Interpersonal skills and excellent Customer Service skills.
- Ability to present a professional image when interacting with all levels of staff.
- Ability to write reports, business correspondence and procedures.
- Ability to effectively present information and respond to questions from government entities, employees, leadership team, and physicians
- Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions. Ability to deal with problems involving a few concrete variables in standardized situations
- Ability to recognize, evaluate, solve problems, and correct errors, and to develop processes that eliminate redundancy
- Ability to work under minimum supervision and demonstrate strong initiative
- Ability to deal in an organized manner with problems involving multiple variables within the scope of the position
- Ability to make independent decisions when circumstances warrant; make prompt and accurate judgments regarding Coding and other office duties
- Ability to conceptualize workflow, develop plans, and implement appropriate actions
-
Coding Manager
1 month ago
Tampa, United States The Judge Group Full timeJob Title: Manager of Coding QualityLocation: Tampa, FL 33634 (Hybrid Role, two days per week in office))Our client is currently seeking a skilled Manager of Coding Quality to join their team. As a direct hire position, this role offers a competitive starting salary and the opportunity to make a significant impact.Responsibilities:Provide coding and coding...
-
Coding Manager
3 weeks ago
Tampa, United States The Judge Group Full timeJob Title: Manager of Coding QualityLocation: Tampa, FL 33634 (Hybrid Role, two days per week in office))Our client is currently seeking a skilled Manager of Coding Quality to join their team. As a direct hire position, this role offers a competitive starting salary and the opportunity to make a significant impact.Responsibilities:Provide coding and coding...
-
Coding Manager
1 month ago
Tampa, United States The Judge Group Full timeJob Title: Manager of Coding QualityLocation: Tampa, FL 33634 (Hybrid Role, two days per week in office))Our client is currently seeking a skilled Manager of Coding Quality to join their team. As a direct hire position, this role offers a competitive starting salary and the opportunity to make a significant impact.Responsibilities:Provide coding and coding...
-
Coding Manager
6 days ago
Tampa, United States The Judge Group Full timeJob Title: Manager of Coding QualityLocation: Tampa, FL 33634 (Hybrid Role, two days per week in office))Our client is currently seeking a skilled Manager of Coding Quality to join their team. As a direct hire position, this role offers a competitive starting salary and the opportunity to make a significant impact.Responsibilities:Provide coding and coding...
-
Medical Coding Quality Manager
7 days ago
Tampa, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Medical Coding Quality Manager for on-site work in Tampa, FL. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Medical Coding Quality Manager
4 weeks ago
Tampa, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Medical Coding Quality Manager for on-site work in Tampa, FL. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Medical Coding Quality Manager
4 weeks ago
Tampa, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Medical Coding Quality Manager for on-site work in Tampa, FL. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Medical Coding Quality Manager
3 weeks ago
Tampa, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Medical Coding Quality Manager for on-site work in Tampa, FL. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Medical Coding Quality Manager
3 weeks ago
Tampa, United States Equity Staffing Group Full timeEquity Staffing Group is currently staffing a Medical Coding Quality Manager for on-site work in Tampa, FL. This is contract work with a Fortune 100 organization. Our client serves more than 85 million people and has a reputation for bold ideas. If you enjoy working with energetic people in a collaborative environment, we want to speak with you!Position:...
-
Risk Manager
2 weeks ago
Tampa, United States AdventHealth Full timeDetails **Posted**: 13-Apr-24 **Location**: Tampa, Florida **Salary**: Open **Internal Number**: 136486006 **Work Hours/Shift** **Florida Hospital Tampa** Our hospital has celebrated many firsts in Tampas health care history since we opened our doors in 1968. Today, more than four decades later, Florida Hospital Tampa continues to offer innovative...
-
Tampa, Florida, United States Distinctive Living Full timeWelcome to Distinctive Living! We are currently looking for a dedicated Vice President of Quality and Risk Management to join our team at Distinctive Living. Our main goal is to support our employees in achieving their full potential by offering opportunities for personal and professional growth. We prioritize creating a culture where everyone feels valued...
-
Client Manager, Commercial Risk-BKS Partners
4 weeks ago
Tampa, United States Baldwin Risk Partners Full timeBKS Partners is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take...
-
Tampa, Florida, United States Baldwin Risk Partners Full timeBKS Partners is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take...
-
Client Manager, Commercial Risk-BKS Partners
4 weeks ago
Tampa, United States Baldwin Risk Partners Full timeBKS Partners is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take...
-
Client Manager, Commercial Risk-BKS Partners
3 weeks ago
Tampa, United States Baldwin Risk Partners Full timeBKS Partners is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take...
-
Relationship Manager, Private Risk
4 weeks ago
Tampa, United States Baldwin Risk Partners Full timeThe Relationship Manager serves as the primary contact for clients providing world-class client service, technical expertise and proactive risk management. Principal Responsibilities: Provides proactive day-to-day client service by anticipating and evaluating client needs and responding to client questions and issues in person, via email or by telephone....
-
Relationship Manager, Private Risk
3 weeks ago
Tampa, United States Baldwin Risk Partners Full timeThe Relationship Manager serves as the primary contact for clients providing world-class client service, technical expertise and proactive risk management. Principal Responsibilities: Provides proactive day-to-day client service by anticipating and evaluating client needs and responding to client questions and issues in person, via email or by telephone....
-
Wholesale Lending Credit Risk
5 days ago
Tampa, United States Citi Full time**The Data Quality Analyst II is a developing professional role. Applies specialty area knowledge in monitoring, assessing, analyzing and/or evaluating processes and data. Identifies policy gaps and formulates policies. Interprets data and makes recommendations. Researches and interprets factual information. Identifies inconsistencies in data or results,...
-
Claims Consultant, Commercial Risk
4 days ago
Tampa, Florida, United States Baldwin Risk Partners Full timeRogersGray, A Baldwin Risk Partner, is a place where smart, dedicated, ambitious, and motivated people come together to build something meaningful. We work hard, brainstorm often, and laugh a lot. If you want the opportunity to work in a supportive environment, challenge yourself and learn new skills, we want to talk to you. Position Summary: The Claims...
-
Client Executive, Commercial Risk-BKS Partners
4 weeks ago
Tampa, United States Baldwin Risk Partners Full timeBKS Partners is an award-winning entrepreneur-led and inspired insurance brokerage firm delivering expertly crafted Commercial Insurance and Risk Management, Private Insurance and Risk Management, Employee Benefits and Benefit Administration, Asset and Income Protection, and Risk Mitigation strategies to clients wherever their passions and businesses take...
