Head of Coding Quality Assurance
1 week ago
Overview
Role Summary:
The Director of Coding Integrity plays a pivotal role in overseeing the data collection and clinical coding processes for skilled admissions, ensuring that TMC: Therapy Management Corporation adheres to the highest standards of coding accuracy for all skilled claims submitted to Medicare and other insurance entities. This position necessitates a profound understanding of HCPCS and ICD-10 coding guidelines, Medicare regulations, compliance, and documentation practices. Key responsibilities include managing training initiatives with facilities to promote appropriate documentation and coding practices for MDS completion, as well as supervising the personnel within the Coding Integrity Division.
Key Responsibilities:
Leadership and Management: Provide strategic direction for coding integrity across all rehabilitation disciplines. Supervise and evaluate the performance of Coding Integrity Division staff, including managing training and development. Ensure timely completion and submission of MDS Recommendations Reports for skilled patient admissions. Clinical Coding Expertise: Act as the primary expert in clinical coding, ensuring adherence to RAI Guidelines, HCPCS, ICD-10 coding standards, and Medicare regulations. Offer insights and recommendations for appropriate coding based on clinical documentation reviews. Maintain ongoing monitoring of coding activities to ensure compliance with Medicare and other insurance providers. Quality Assurance and Metrics: Develop, implement, and monitor performance metrics to enhance the efficiency of the Coding Integrity Division. Provide regular updates to the VP of Reimbursement & Regulatory Compliance regarding coding activities and MDS completion. Establish and execute quality assurance programs aimed at preventing MDS and coding denials. Training and Educational Development: Coordinate training sessions with facilities to enhance documentation and coding practices for MDS completion. Create comprehensive training materials and educational resources to ensure compliance with Medicare coding standards. Identify and mentor key personnel in ICD-10 coding and MDS proficiency. Client Interaction and Support: Serve as the main contact for clients, including facility managers and external stakeholders, regarding coding-related inquiries. Effectively communicate with clients to resolve coding integrity concerns and provide guidance on compliance improvements. Collaborate with operational teams to ensure efficient resolution of client issues and enhance coding accuracy. Collaborative Engagement: Engage in the development and execution of action plans for facilities experiencing coding challenges, working closely with Regional Directors. Act as a liaison for Medicare and Fiscal Intermediaries, keeping stakeholders informed of regulatory changes. Support facility onboarding and orientation processes as necessary. Industry Participation and Continuous Improvement: Attend relevant Medicare Intermediary and provider meetings, summarizing key points for the VP of Reimbursement & Regulatory Compliance. Contribute articles to quarterly newsletters focusing on coding improvement strategies and updates on Medicare regulations. Additional Duties: Undertake other responsibilities as assigned, including involvement in company-wide initiatives related to coding integrity and compliance.Required Qualifications:
Proven leadership and management experience in overseeing a coding or clinical documentation team. Highly organized with the ability to manage multiple responsibilities effectively. In-depth knowledge of ICD-10 and HCPCS coding guidelines, Medicare regulations, and compliance standards. Expertise in reviewing clinical documentation and applying accurate coding practices. Strong training and educational skills, capable of designing and delivering effective training programs related to coding integrity. Excellent written and verbal communication skills, with the ability to create detailed reports and educational content. Demonstrated experience in customer service and relationship management, with the ability to discuss coding issues professionally. Background in coding compliance and quality assurance, familiar with developing quality assurance processes. Strong analytical skills and technical proficiency, capable of interpreting coding metrics and regulatory guidelines. Comprehensive knowledge of regulatory frameworks, particularly Medicare and Medicaid regulations, and MDS guidelines.Educational Background:
Experience with PDPM and MDS coding. Graduate from an accredited nursing program. Current nursing license in the relevant geographic area. Minimum of 3 years of related experience. Ability to lift and manage weights up to 50 pounds.-
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