Coding & Compliance Manager, Surgery

Beth Israel Lahey Health

11d•$92,955 - $125,091•Onsite

About The Position

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. This position is responsible for facilitating the coding, auditing and billing process according to CMS, BIDMC, other federal insurance programs, third-party billing and compliance regulations and guidelines. Oversees and directs efforts across the Department of Surgery to streamline the compliant coding and revenue cycle process with the ultimate goal of optimizing the reimbursement process.

Requirements

High School diploma or GED required.
Certificate 1 Certified Professional Coder required.
5-8 years related work experience required.
Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases.

Nice To Haves

Bachelor's degree preferred.
Certified Professional Compliance Officer (CPCO)

Responsibilities

Oversees the scope, direction, and effectiveness of the coding team in supporting and maintaining the department billing protocols, standards, compliant coding and needs. Provides guidance to coders and audits work as needed to assure accuracy.
Develops and implements coverage models including cross-training staff to multiple specialties; ensures defined expectations and coding consistency. Communicates all pertinent and changing regulations to team, faculty, and divisions within the department. Leads weekly/monthly meetings to review and update staff.
Samples medical documentation to ensure coding and billing compliance within the department to identify possible trends and training needs and/or areas that require performance/process improvement. Researches and analyzes data, draw conclusions, and resolve issues.
Monitors, proposes, and minimizes billing and coding operational inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials/appeals as well as developing and implementing corrective action plans for setting performance targets.
Presents audit results to appropriate recipient(s) and conducts presentations/training sessions. Develops and administers ongoing physician, fellow and nurse practitioner education training sessions including documentation guidelines, new/revised/deleted codes, medical necessity and modifier principles.
Plans and oversees the daily work activities of the coding team and provides ongoing feedback regarding training needs, staff performance and process improvement. May provide recommendations to Director on hiring, terminations and corrective action as well as contributing feedback during the performance review process.
Serves as point person for all HMFP audits of medical documentation and post payment audits. Responsible for working with HMFP Compliance and the department, providers and billing services to ensure compliant billing and documentation is promoted throughout the department.
Provides coding services to the division(s). Works with the billing service to resolve denials and other billing issues.
May perform additional job duties as time permits, such as: ensuring appropriate compliance and attainment of projected revenue cycle goals; collaborating to streamline revenue cycle process with the goal of optimizing the reimbursement process; verification of compliance accuracy related to E&M and procedural coding, documentation requirements and chargeticket entry/billing process.
May perform additional job duties as time permits, such as: developing and presenting performance metric reports with a review of findings with Attending Physicians, Directors, Managers and Chiefs; service on committees; maintains relationship with third party billing companies to ensure continuous excellence in services; fosters relationships with affiliates related to coding and compliance.