Mgr, Revenue Integrity Operations

3 weeks ago

Irving, United States Pacific Dental Services Full time

Now is the time to join Pacific Dental Services. You will have opportunities to learn new skills from our team of experienced professionals. If you're ready to take your career to the next level and gain valuable experience, apply today

The Revenue Integrity Operations Manager will be responsible for enhancing transparency, maintaining relationships, and supporting the education of medical professionals and coders. The individual in this position will work closely with executive leadership to identify and resolve problems related to coding, documentation and/or education. The Revenue Integrity OperationsManager will provide feedback to medical professionals in accordance with medical documentation guidelines as it relates to billing and coding activities. This will include providing extensive education regarding ICD 10 and CPT to coding staff and medical professionals in adherence to regulatory guidelines. The successful individual will demonstrate the ability to work effectively and collaboratively with other internal departments. The Revenue Integrity Operations Manager will also be responsible for coding analysis, feedback and education as needed.

Responsibilities

* Provide effective leadership, coaching, mentoring, training, development, performance evaluations of team members.


* Performs Human Resources related functions, such as interviewing and selecting, performance appraisals, disciplinary actions and salary administration to maintain a staff suitable to meet department objectives.


* Serve as a coding expert for assigned specialties and stay abreast of specialty society updates regarding procedure and coding trends for assigned areas.


* Provide training and education to new and existing coders and medical professionals.


* Act as a resource between coders and providers through education around proper documentation of services provided, and explanation of when services are not eligible for separate reimbursement.


* Serve as a resource in responding to questions that arise following provider review of Weekly Charges Summary report.


* Assist in identifying educational needs based on feedback from revenue cycle teams, coding audits, and weekly charges summary reports.


* Correspond with physicians regarding medical documentation, billing, and coding guidelines.


* Review new policies, procedures, standards and guidelines pertaining to medicaldocumentation, billing, coding, and compliance to ensure an up-to-date knowledge and experience level.


* Read publications and attend seminars to remain current on correct coding and billing procedures.


* Perform retrospective review of documentation to identify areas where documentation deficiencies may have led to lost revenue.


* Collaborate with leadership to identify areas of needed education for coders and providers.


* Review charge correction requests to identify educational opportunities.


* Analyze and research correct coding for new CPT codes and make recommendations to ensure compliant coding of existing procedures.


* Maintain responsibility for edit analysis to identify educational opportunities and edit modification.


* Use data analytics to identify trends in service mix and payer denials, and work in tandem with management to enhance revenue cycle performance.


* Collaborate with Audit, Compliance and Education to ensure reliable and transparent communication among all stakeholders.


* Assist with development and maintenance of desk procedures.


* Provide oversight and direction to offshore team as it relates to coding.


* Perform other duties and assist with special projects as assigned by leadership.



Knowledge/Skills/Abilities

* Bachelor's Degree in Business Management or a related field. In lieu of a degree, +8 years of experience is required or one of the combinations of education and experience.


* 6+ years related work experience.


* Requires a CPC or AHIMA coding certification.


* Must have 3+years' coding experience and proficiency across a wide range of services.


* Knowledge of CMS and local carrier regulations and requirements for documenting/billing physician services at a teaching hospital is helpful.


* Experience training/educating medical professionals in medical documentation, billing, coding, revenue cycle and compliance guidelines is a plus.


* A minimum of 3 years' experience with demonstrated expertise in procedural and diagnosis coding and teaching physician guidelines is strongly preferred.


* Must portray excellent interpersonal and communication skills.


* The ability to use data analytics tools and resources is key. Requires strong Microsoft Office, EMR, and Practice Management software experience, Epic experience preferred but not required.


* The ability to establish and maintain cooperative working relationships with physicians and staff is essential to success.



Benefits

* Medical, dental, and vision insurance
* Paid time off
* Tuition Reimbursement
* 401K
* Paid time to volunteer in your local community

Pacific Dental Services is an Equal Opportunity Employer. We celebrate diversity and are united in our mission to create healthier and happier team members.

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