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Manager - Coding Audit Education and Quality Assurance

1 month ago

Scarborough, United States Maine Medical Center Full time
Summary
  • Fully remote with flexible hours
  • The Coding Audit Education and Quality Assurance Manager manages a team of DRG Validation Specialists/Educators, Outpatient Quality Compliance auditors, Clinical Coding Compliance auditors, and Behavioral Health Clinical Coding audit educators. The Coding Audit Education and Quality Assurance Manager will directly supervise the provision of medical audit reviews and corresponding analysis to support acceptable and compliant charging, billing and documentation practices for the Maine Health system. This role oversees and validates the statistical reports and analysis of audit findings and delivers them to Coding Leadership, Central Business Office Leaders, and the Maine Health Audit Committee with subsequent process improvement recommendations. The Coding Audit Education and Quality Assurance manager assists with responses and education to the ongoing corporate risk audit process and the development of the educational follow-up work plan, as required.

    Required Minimum Knowledge, Skills, and Abilities (KSAs)
    • Education: A Bachelors' degree in Healthcare Administration, HIM or a related business field is required.
    • License/Certification: Possess one or more of the following certifications: CPC, COC, CPMA, CHC, CPCO, CCS-P, CCS, RHIA, RHIT or CIC.
    • Experience: Five or more years' progressive healthcare compliance audit and/or coding experience. Prior management experience preferred.
    • Must have in-depth knowledge of hospital, medical and behavioral practice organizational structure. CAH, RHC, and FQHC experience is helpful.
    • Must possess the leadership and analytical ability to guide the auditing team through planning, research, fieldwork, reporting analysis and summary documentation activities throughout the audit continuum, while meeting expectations and deadlines as assigned.
    • Ability to analyze and interpret clinical and administrative healthcare data and communicate at a college level, in both verbal and written formats.
    • Knowledge of physician and hospital billing practices, CMS regulations, CPT coding guidelines from the American Medical Association, DRG methodology, as well as knowledge of the AHA Coding Clinic, commercial payer guidelines, state and federal healthcare regulatory guidance and the ability to research and analyze this information within the structure of a healthcare audit.
    • Ability to establish and maintain effective and ethical working relationships with physicians, attorneys, administrators, supervisors, subordinates, outside agency personnel, and all levels of hospital personnel in relation to appropriate documentation practices and compliance.
    • Must be able to communicate effectively in a variety of settings with MaineHealth staff and Audit Committee through documents, reports, discussion and electronic methods.
    • Ability to maintain the strictest confidentiality in the performance of duties.
    • Proficiency in Microsoft Office is required. Epic, or other healthcare EHR experience is preferred.
    • Demonstration of integrity, maturity, dependability, stamina, positive attitude and enthusiasm in the performance of responsibilities.

Additional Information
MaineHealth is a health system whose members and affiliates include hospitals, physician practices, long-term care facilities, home care agencies, and support services. Learn more about this system at www.mainehealth.org