PACE Coding Manager
Found in: Talent US C2 - 2 weeks ago
Responsible for developing, implementing, and maintaining risk adjustment functions and processes for San Diego PACE, leading a team of coding auditors, and facilitating the improvement in overall quality, compliance, completeness, appropriateness, and accuracy of documentation and coding for professional services.
While reporting to the San Diego PACE Finance Director, will work collaboratively with operations and clinical leadership to improve coding and documentation performance.
Essential Functions of the Job:
Responsible for developing, implementing, and maintaining risk adjustment functions and processes for San Diego PACE to facilitate improvement in overall quality, completeness, appropriateness, and specificity of documentation. Hire, lead, train, and oversee a successful team of coding auditors and manage their performance to create a cohesive and highly effective team. Contribute actively to new clinical program development through creation of training tools, resources, procedures, and workflows for providers and San Diego PACE coding auditors. Educate, train, onboard, and communicate effectively with the team of providers on accurate, complete, and compliant documentation and coding practices and hold regular and episodic provider training initiatives. Assess current compliance activities and evaluate risk factors in coding and documentation practices and implement strategies to mitigate risk by educating providers and coders. Responsible for timely review of all billable encounters prior to claims submission for accuracy and completeness and comprehensive concurrent coding reviews and audits of a subset of encounters, with emphasis on documentation quality, accuracy, completeness, compliance, and specificity. Establish, implement, and maintain a formalized review process for coding and documentation compliance, including a formal audit process and quality control. Communicate with the providers in real time prior to claims submission or redaction through coding queries regarding need for clarification, amendment, or modification of specific patient encounters, following compliant practices to optimize documentation accuracy, specificity, and completeness. Work with the provider team and center operations on timely closure of encounters and completion of tasks related to documentation and coding practices. Oversee successful and timely bi-annual creation of redaction and submission Risk Adjustment Processing System (RAPS) files to the Center of Medicare and Medicaid Servicer (CMS). Contribute to successful transitions of vendors, including Electronic Health Records, to minimize potential burden and vulnerabilities, and improve clarity of expectations pertinent to documentation and coding practices, including development, training, and implementation of new workflows and processes for the impacted teams. Meet with external vendors and internal resources and stakeholders monthly to review coding analytics dashboards and reports, gain a deep understanding of current and past performance, identify trends, opportunities, and future strategies, and communicate those with the San Diego PACE leadership team and ensure necessary actions are taken by appropriate teams and individuals to address gaps in performance. Stay current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS and CPT coding and serve as a Subject Matter Expert to collaborate and communicate existing and new guidelines with other departments, such as medical practice, operations, and finance. Routinely reevaluate existing workflows to identify opportunities for improvements, standardization, or re-education to increase efficiency and accuracy of documentation and coding for all services and providers. Serve as a resource to bridge the gaps between the clinical providers and coders and facilitate resolution of documentation and coding issues. Provide timely feedback to the coders and auditors and take corrective action to ensure highly effective practices. In collaboration with Coders and PACE Finance Director, periodically reviews reimbursement trends by Hierarchical Condition Category (HCC) codes to evaluate opportunities and identify payment issues, making recommendations for changes, as necessary. Proficient with ICD-10 and CPT coding as well as E&M and all professional coding guidelines for large multi-specialty provider groupsAdditional Duties and Responsibilities:
Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars. Provide direction, management, and supervision to ensure efficient operation of assigned departments. Coordinate with Other PACE departments to develop standardized processes and gain system-wide efficiencies. Function as a cross-functional collaborator, build trust, and communicate effectively with central and site-specific leadership, stakeholders, and providers throughout the organization. Performs other related duties as assigned or requested.Job Requirements
Experience Required:
Education Required:
High School Diploma or GED equivalentCertifications Required:
Active and current Certified Procedural Coder (CPC) accreditation by an accredited organization or college, such as the AAPC, that meet the state licensure requirements; Incumbent is required to maintain an “Active” license status as a term of employment. CA Driver's license with appropriate insurance coverageVerbal and Written Skills Required to Perform the Job:
Excellent verbal and written communication skills Comfortable speaking with people at an executive level or physician level Ability to communicate effectively both verbally and in writing in EnglishTechnical Knowledge and Skills Required to Perform the Job:
Experience with EMR system such as Epic preferred but not required. Knowledge of Microsoft Office software. A thorough understanding of CPT, HCC and ICD-10 coding. Math ability to calculate and accurately analyze various accounts.Equipment Used:
General office equipment to include PC and Software (Excel, Word, Office), phone, fax, etc.Working Conditions and Physical Requirements:
This position is intended to be primarily remote, with a minimum weekly expectation for on-site presence (Provider Education Meetings, etc.) General Office Environment; Prolonged periods of sitting, and constant walking and standing. May be required to work evenings and/or weekends. Some travel required for meetings and trainings.Universal Requirements:
Pre-employment requirements include I-9, physical, positive background and reference check results, complete application, new hire orientation, pre-employment PPDs. Compliance with all mandated vaccinations and all boosters is a term and condition of employment.
-
Pace Mobile Registered Nurse
5 days ago
San Marcos, United States Gary and Mary West PACE Full time**_This is a fantastic job for somebody who likes to be out in the field._** **_ Gary and Mary West PACE is a growing and thriving all inclusive day center for the fragile elderly._** **We are located in San Marcos, CA.** **We offer several benefit plans to chose from and also have a great 403B program.** **Come work for a company with a wonderful...
-
Coding Supervisor
5 days ago
San Diego, United States San Ysidro Health Full time**Position Summary**: Responsible for developing, implementing, and maintaining a system-wide quality management plan and facilitating improvement in overall quality, completeness, appropriateness and accuracy of documentation and coding for professional services. Will work cooperatively with the Sr. Director of Revenue Cycle and will review coding and...
-
Certified Coding Supervisor
Found in: Lensa US P 2 C2 - 7 days ago
San Diego, United States iConsultera Full timeJob Title: Coding SupervisorDuration: 3 Months Temp to hireLocation: San Diego, CA (Remote job, have to visit the facility for 3-4 days in a month for meetings)Shift: M-F 8 am to 5 pmPosition Summary:Responsible for developing, implementing, and maintaining a system-wide quality management plan and facilitating improvement in overall quality, completeness,...
-
Coding Supervisor
Found in: Lensa US P 2 C2 - 7 days ago
San Diego, United States Amtec Global Solutions Inc Full timeJob Description Job Description Job Title: Coding Supervisor Location: Remote Type: Temp to Hire - 17 weeks Salary Range : $77K-$110K Position Summary: Responsible for developing, implementing, and maintaining a system-wide quality management plan and facilitating improvement in overall quality, completeness, appropriateness and accuracy of documentation and...
-
Coding Supervisor
Found in: Lensa US P 2 C2 - 1 week ago
San Diego, United States CareerBuilder Full timeJob Title: Coding Supervisor Location: San Ysidro, CA Hybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week. Schedule: Monday Friday, 8am 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am 6pm. Duration: Temporary to Permanent (based on performance and business need). Pay:...
-
Coding Supervisor
Found in: Lensa US P 2 C2 - 2 weeks ago
San Diego, United States Manpower San Diego Full timeJob Title: Coding Supervisor Location: San Ysidro, CA Hybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week. Schedule: Monday Friday, 8am 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am 6pm. Duration: Temporary to Permanent (based on performance and business need). Pay:...
-
Coding Supervisor
Found in: Appcast US C2 - 2 weeks ago
San Diego, United States Manpower San Diego Full timeJob Title: Coding SupervisorLocation: San Ysidro, CAHybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week.Schedule: Monday – Friday, 8am – 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am – 6pm.Duration: Temporary to Permanent (based on performance and business...
-
Coding Supervisor
Found in: Lensa US P 2 C2 - 3 days ago
San Diego, United States Manpower San Diego Full timeJob Title: Coding Supervisor Location: San Ysidro, CA Hybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week. Schedule: Monday – Friday, 8am – 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am – 6pm. Duration: Temporary to Permanent (based on performance and business...
-
Coding Supervisor
Found in: Appcast Linkedin GBL C2 - 2 weeks ago
San Diego, United States Manpower San Diego Full timeJob Title: Coding SupervisorLocation: San Ysidro, CAHybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week.Schedule: Monday – Friday, 8am – 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am – 6pm.Duration: Temporary to Permanent (based on performance and business...
-
Coding Supervisor
2 weeks ago
San Diego, United States Manpower San Diego Full timeJob Title: Coding SupervisorLocation: San Ysidro, CAHybrid: Remote, and requires attendance of provider meetings 1 week out of the month for 3-4 days of that week.Schedule: Monday – Friday, 8am – 5pm. Or the option to complete 8 hours of work anytime between the hours of 6am – 6pm.Duration: Temporary to Permanent (based on performance and business...
-
Coding Supervisor
2 weeks ago
San Diego, United States Amtec Global Solutions Inc Full timeJob DescriptionJob DescriptionJob Title: Coding SupervisorLocation: RemoteType: Temp to Hire - 17 weeksSalary Range: $77K-$110K Position Summary: Responsible for developing, implementing, and maintaining a system-wide qualitymanagement plan and facilitating improvement in overall quality, completeness,appropriateness and accuracy of documentation and...
-
PACE Registered Nurse
7 days ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityRemember to check your CV before applying Also, ensure you read through all the requirements related to this role.Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community...
-
PACE Registered Nurse
5 days ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityRemember to check your CV before applying Also, ensure you read through all the requirements related to this role.Family Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community...
-
PACE Registered Nurse
5 days ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
2 weeks ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
1 week ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
2 weeks ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
7 days ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
7 days ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
-
PACE Registered Nurse
36 minutes ago
San Diego, United States Family Health Centers of San Diego Full timeImpact Lives, Impact CommunityFamily Health Centers of San Diego (FHCSD) is passionate about providing exceptional health care to all, especially underserved communities with limited health care options. Founded by a Latina grandmother/community advocate over 50 years ago in Barrio Logan, FHCSD has grown into one of the largest community health systems in...
