Manager-Clinical Documentation and Coding Compliance Services

3 months ago

Louisville, United States Blue & Co. Full time
Job DescriptionJob Description

Blue & Co., LLC is currently seeking a Subject Matter Professional to lead its Clinical Documentation and Coding Compliance service offerings. The job title is Manager of Clinical Documentation and Coding Compliance Services and will be a member of Blue’s broader Revenue Cycle team. The position will consist of leading and managing projects pertaining to coding and documentation compliance across a wide variety of specialties, primarily anticipated to be Medicare Part B Professional services but potentially hospital outpatient, hospital-based and/or urgent care services as well. The role will also require managing additional staff through project management quality control oversight. This role is integral to Blue’s strategy for building and further diversifying our service offerings and team footprint in the coding and clinical documentation compliance space.

Position Requirements:

  • Certified Professional Coder (CPC) required. Certified Risk Coder (CRC) additionally preferred. Other certifications welcomed including but not limited to: Certified Professional Medical Auditor (CPMA) Certified Coding Specialist – Physician (CCS-P), Certified Outpatient Coder (COC), AHIMA approved ICD-10-CM/PCS trainer, Registered Health Information Administrator (RHIA), Registered Health Information Technician (RHIT), Registered Nurse (RN).
  • Bachelor’s Degree in a Healthcare Related Field. Master’s Degree is desirable.
  • Establish and be accountable for project budget performance metrics; including assisting in determining project workplans, resource allocation models, timelines and resource requirements; proactive project status updates and issue identification/resolution; and quality control over project team member performance as necessary for development of project artifacts, deliverables and reports.
  • Assume responsibility for ongoing maintenance of license/certification requirements and continued professional development through participation in internal and external CEU activities, workshops, conferences and/or in-services and maintain appropriate records of participation.
  • Maintain updated clinical knowledge and stay abreast of guidelines and regulations affecting Clinical Documentation and Coding requirements, Professional Coding and Reimbursement models, Alternative Payment Models, Risk Adjustment mechanisms.
  • Maintain fluency in software commonly used in the clinical documentation and coding realm including encoders and EMR’s through a combination of client facing activities and industry knowledge gained through previous and ongoing experience.

Experience and Skills:

This is a hands-on role that works with Physicians and other Clinical Practitioners, physician and medical, rehabilitative, behavioral health, substance abuse, urgent care, DME practices/services, attorneys, private equity owners, etc. Projects typically include reactive investigations in defense of third-party assertions, demand letters, audits or other inquiries, voluntary investigations of compliance risks or areas of concern, voluntary disclosures, service in the capacity of Independent Review Organization (IRO), transaction due diligence assistance for coding and clinical documentation compliance/risk and coding and billing process improvement opportunities for staffing, workflow, etc. Increasing concerns with Risk Adjustment coding (Hierarchical Condition Categories, etc.) is also expected. Most work is contemplated to be remote, but travel is required when necessary. Must have confidence in coding domain with scrutiny of work by third party constituents. Most engagements target government payors and related concerns but commercial payors and or commercial payor specific assertions/concerns are also included.

  • Demonstrated ability to discern and interpret complex data sets to diagnose root cause or performance variances and design remediation strategies based on data and observations.
  • Articulated experience with professional coding, procedural coding, drugs, supplies, infusions, implants, modifier application, etc. across multiple specialties.
  • Articulated experience with ‘incident to’, split-shared services, global billing, supervision requirements, physician versus non-physician billing provider requirements, etc. as they pertain to billing reimbursement requirements.
  • Working knowledge of federal, state and payer specific regulations and policies pertaining to clinical documentation and coding including value based/pay-for-performance programs.
  • Working knowledge of official coding guidelines, CMS and commercial payer regulations, including NCD and LCD’s.
  • Working knowledge of CMS Mandatory and Voluntary alternative payment models (Medicare Advantage, Value Based Purchasing, Readmissions Reduction Program, Mortality Reductions Programs, Comprehensive Joint Care BPCI-A, MIPS and MACRA) and applicability to the Clinical Documentation, Coding and Quality Improvement domains.
  • Strong grasp of risk adjustment concepts and impacts to Alternative Payment Models and Quality Programs.
  • Able to analyze complex clinical scenarios and apply critical thinking.
  • Must be self-directed, able to organize and manage multiple concurrent projects, balancing client needs with other demands on time.
  • Computer knowledge of MS Office, Excel, Adobe, Tableau, MS Word, and MS PowerPoint.
  • Software fluency with common Coding and EMR platforms, workflows and tools.

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