Director | Coding Audit and Education

Avera•Sioux Falls, SD

About The Position

The Director - Coding Audit & Education is responsible for complex and multi-faceted strategic planning and implementation for Avera system coding audit and education plans, strategies and programs. Requires extensive coordination and development of annual work plans and flexible planning for critical area needs for both ambulatory and acute coding areas. Works closely with executive leaders, including revenue cycle, health information, revenue integrity, clinical documentation, quality improvement, compliance, legal and other committees. This position requires problem solving, investigation and analysis to run, monitor and grow programs necessary to mitigate risk and continued development of coding compliance initiatives to produce effective results. Evaluates resource needs and program changes to effectively impact quality, service, effectiveness, costs, methods and employee performance. Strategizes and deploys team compliance with state and local guidelines, regulations, CMS requirements, and applicable third-party payor guidelines as appropriate to coding. Position requires the ability to influence, lead and develop professional individuals including other people leaders and high performing individual contributors in the areas of revenue cycle, coding, auditing inside and outside areas of responsibility as applicable to coding compliance and risk mitigation. Position must be able to articulate fluently with internal and external stakeholders.

Requirements

Must have knowledge and skill with code sets and various payment methodologies for a large health system including hospitals with prospective payments systems, fee schedules, critical access hospitals, and clinic settings.
The individual must be able to work the hours specified.
To perform this job successfully, an individual must be able to perform each essential job function satisfactorily including having visual acuity adequate to perform position duties and the ability to communicate effectively with others, hear, understand and distinguish speech and other sounds.
These requirements and those listed above are representative of the knowledge, skills, and abilities required to perform the essential job functions. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential job functions, as long as the accommodations do not cause undue hardship to the employer.
Bachelor's in health information management or an acceptable related field.
AHIMA Membership - American Health Information Management Association (AHIMA) or similarly related credential. Upon Hire
Certified Inpatient Coder (CIC) - American Academy of Professional Coders (AAPC) or similarly related credential. Upon Hire
Certified Outpatient Coder (COC) - American Academy of Professional Coders (AAPC) or similarly related credential. Upon Hire
10+ years in multi-specialty coding, coding auditing, education or related quality improvement work with ICD-10 and CPT code sets.

Nice To Haves

Master's

Responsibilities

Accountable for the development, implementation, and maintenance of department strategic plans, programs, projects, performance and systems that enable goals to be met.
Collaborates with department leaders in coding for the development of annual education audit plan and objectives with coding leadership team, including revenue integrity designee.
Oversee all audit activities and reports for continuous improvement, feedback, and monitoring.
Establishes team goals and strategy for overall success in coding compliance and feedback to executive leaders, revenue cycle leaders, physician leaders, compliance and others as necessary.
Works closely with service line leaders, coding denials team leaders, and coding leaders to determine when action plans are necessary versus educational opportunities. Includes areas that see little improvement between audits.
Must be able to manage and oversee and progress through multiple projects and meet deadlines for the overall audit plan without compromise to quality.
Demonstrate excellent organizational skills, self-motivation and time management accountability.
Establishes system process along with coding leadership teams to be accountable for payer/coding updates and requirements for the various payers provided by the contract management team. Includes commercial payers contract management plans and Medicare Contractors. Avera encompasses Noridian Healthcare Solutions, National Government Services (NGS), Novitas Solutions, Wisconsin Physician Service (WPS), and CGS Administrators.
Serves as a liaison for coding disparities between health plans and the provider community when brought to attention by revenue integrity, revenue cycle, compliance or coding leadership teams. Ability to negotiate and compromise conflicts through influence with internal and external audiences.
Helps foster necessary discussion and collaboration to bring awareness to areas of disagreement by assisting with meetings and involving contract management when necessary.
Seeks opportunity for innovation and technology vision for process improvement and plans for resources and budgets to support initiatives.
Responsibilities include interviewing, hiring, developing people/team, planning, and overseeing audit activities; policies and standard operating procedures; appraising and monitoring performance; rewarding and coaching employees; addressing complaints and resolving problems.
Responsibilities include interviewing, hiring, developing, training, and retaining employees; planning, assigning, and leading work; appraising performance; rewarding and coaching employees; addressing complaints and resolving problems.