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Head of Coding Compliance
2 months ago
Overview
Scope:
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 demands a comprehensive understanding of HCPCS and ICD-10 coding guidelines, Medicare regulations, compliance protocols, and documentation practices. Key responsibilities include managing training initiatives with facilities to enhance documentation and coding for MDS completion, as well as supervising the personnel within the Coding Integrity Division.
Duties and Responsibilities:
Leadership and Oversight: Provide strategic leadership and direction for coding integrity across all rehabilitation disciplines. Supervise and evaluate the performance of Coding Integrity Division personnel, coordinating necessary training and development. Manage all personnel-related tasks, including scheduling and performance assessments, while ensuring timely completion and submission of MDS Recommendations Reports for skilled patient admissions. Clinical Coding and Compliance: Act as the clinical coding authority, ensuring adherence to RAI Guidelines, HCPCS, ICD-10 coding standards, and Medicare regulations. Offer expertise in reviewing clinical documentation and recommending precise coding practices. Maintain ongoing monitoring of coding activities to ensure compliance with Medicare and other insurance providers. Quality Assurance and Reporting: Develop, implement, and monitor key performance metrics to enhance the efficiency of the Coding Integrity Division. Provide regular reports to the VP of Reimbursement & Regulatory Compliance regarding coding activities and MDS completion rates. Create and execute quality assurance and improvement programs to mitigate MDS and coding denials. Training and Development: Oversee and facilitate training sessions with facilities on documentation and coding for MDS completion. Design training manuals and educational resources to uphold Medicare-compliant coding integrity processes. Identify and mentor key personnel in ICD-10 coding and MDS expertise. Customer Interaction and Support: Serve as the primary liaison for customers, including facility managers and external stakeholders, regarding coding-related inquiries. Effectively communicate with customers to resolve coding integrity concerns, provide updates, and offer guidance on enhancing compliance. Collaborate with operational teams to ensure efficient resolution of customer issues and improve coding accuracy at client locations. Collaboration and Support: 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 in relevant states, keeping stakeholders informed of regulatory updates. Support facility startup and orientation processes as required. Industry Engagement and Continuous Improvement: Attend Medicare Intermediary and provider meetings, providing summaries to the VP of Reimbursement & Regulatory Compliance. Author quarterly newsletter articles focused on coding improvement strategies, updates, and pertinent Medicare regulations. Other Responsibilities: Undertake additional tasks as assigned, including participation in company-wide initiatives related to coding integrity and compliance.Required Skills:
Strong leadership and management capabilities, with a proven track record in overseeing a coding or clinical documentation team. The candidate should exhibit exceptional organizational skills, capable of managing multiple responsibilities while guiding teams toward achieving coding integrity objectives. In-depth knowledge of ICD-10 and HCPCS coding guidelines, alongside Medicare regulations and compliance standards, is essential. The candidate must demonstrate expertise in reviewing clinical documentation and applying accurate coding practices while remaining current with industry regulations. Effective training and educational skills are crucial. The candidate should be adept at designing, delivering, and managing training programs and educational materials related to coding integrity. Strong presentation and communication skills are necessary for engaging staff and delivering training effectively. Excellent written and verbal communication skills are required, with proficiency in creating detailed reports, summaries, and educational content. The candidate must also be capable of effectively communicating with customers and stakeholders, addressing their needs and concerns related to coding integrity. Proven experience in customer service and relationship management is necessary. The candidate should be comfortable discussing coding issues and solutions with customers, including facility managers and external stakeholders, in a professional and clear manner. A solid background in coding compliance and quality assurance is required. The candidate should be familiar with developing and implementing quality assurance processes and metrics that ensure coding accuracy and regulatory compliance. Analytical and technical proficiency are important for this role. The candidate should possess strong data analysis skills and be able to interpret coding metrics and regulatory crosswalks. Familiarity with software tools for managing coding and documentation is preferred. The role demands extensive regulatory knowledge, particularly in Medicare and Medicaid regulations, MDS guidelines, and industry mandates. The candidate must be capable of staying current with regulatory updates and effectively implementing necessary changes.Qualifications:
Experience with PDPM and MDS Coding Graduate from an accredited nursing program. Current Nursing license within the designated geographic area of their respective nursing profession. Minimum of 3 years related experience. Ability to demonstrate the lifting and controlling of 50 pounds.