Director of Coding Integrity

3 weeks ago

Hattiesburg, United States TMC: Therapy Management Corporation Full time

Overview

Scope:

The Director of Coding Integrity is directly responsible for managing the data collection and clinical coding of skilled admissions to ensure Therapy Management Corporation’s standards are upheld regarding the coding integrity for all skilled claims to be submitted to Medicare and other insurance providers. Position requires providing knowledge and expertise in reviewing and recommending the appropriate coding as supported by clinically relevant documentation. Position requires understanding of HCPCS and ICD-10 coding guidelines, Medicare regulations, compliance, and documentation. Responsibilities include overseeing/coordinating training with facilities regarding appropriate documentation and coding for MDS completion. Responsibilities also include oversight and management of the Coding Integrity Division personnel.

Duties and Responsibilities:

Leadership and Oversight: Provide leadership and direction for coding integrity across all rehab disciplines.Oversee and manage Coding Integrity Division personnel, including monitoring their performance and coordinating training.Manage all personnel responsibilities, including scheduling, performance reviews, and training for Coding Integrity Division staff.Oversee completion and submission of MDS Recommendations Reports for skilled patient admissions. Clinical Coding and Compliance: Serve as the clinical coding expert, ensuring compliance with RAI Guidelines, HCPCS, ICD-10 coding guidelines, and Medicare regulations.Provide knowledge and expertise in reviewing clinical documentation and recommending appropriate coding.Ensure consistent monitoring of coding activity and submission to maintain compliance with Medicare and other insurance providers. Quality Assurance and Reporting: Implement, sustain, and monitor metrics to maintain the efficiency of the Coding Integrity Division.Provide weekly reports to the VP of Reimbursement & Regulatory Compliance regarding coding activity and MDS completion.Develop and implement coding integrity quality assurance/improvement programs to prevent MDS and/or coding denials. Training and Development: Oversee and coordinate training with facilities regarding documentation and coding for MDS completion.Develop training manuals and educational content to ensure Medicare-compliant coding integrity processes.Identify and mentor key employees in ICD-10 coding and MDS expertise. Customer Interaction and Support: Serve as the primary point of contact for customers, including facility managers and external stakeholders, on coding-related matters.Communicate effectively with customers to address coding integrity issues, provide updates, and offer guidance on improving compliance.Collaborate with operational teams to ensure customer concerns are resolved efficiently and to improve coding accuracy at client sites. Collaboration and Support: Participate in creating and implementing action plans for sites with coding issues, working closely with Regional Directors.Act as a liaison for Medicare and Fiscal Intermediaries for applicable states and keep stakeholders informed of regulatory changes.Support facility startup and orientation processes as needed. Industry Engagement and Continuous Improvement: Attend Medicare Intermediary and provider meetings and provide summaries to the VP of Reimbursement & Regulatory Compliance.Write quarterly newsletter articles on coding improvement strategies, updates, and relevant Medicare regulations. Other Responsibilities: Handle additional tasks as assigned, including participating in company-wide initiatives related to coding integrity and compliance.

Required Skills

The role requires strong leadership and management skills, with experience in leading and overseeing a coding or clinical documentation team. The candidate should be highly organized, capable of handling multiple responsibilities, and experienced in guiding teams toward achieving coding integrity goals. A deep understanding of ICD-10 and HCPCS coding guidelines, along with Medicare regulations and compliance standards, is essential. The candidate must have expertise in reviewing clinical documentation and applying accurate coding practices while staying up to date with industry regulations. Effective training and educational skills are critical. The candidate should be able to design, deliver, and manage training programs and educational content related to coding integrity. Additionally, strong presentation and communication skills are needed for engaging staff and delivering training. 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. The candidate must have proven experience in customer service and relationship management. They should be comfortable discussing coding issues and solutions with customers, including facility managers and external stakeholders, in a professional and clear manner. A strong background in coding compliance and quality assurance is necessary. 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 have 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 deep 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:

PDPM Experience and MDS Coding Graduate from an accredited nursing program. Current Nursing license within the designated geographic area of their respective nursing profession. 3 + years related experience. Ability to demonstrate the lifting and controlling of 50 pounds.

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