Director of Ambulatory Documentation Quality and Education

Main Line Health • Newtown Square, PA

2d • Onsite

About The Position

Under the direction of the AVP of Revenue Cycle Operations, this role performs record review of professional billing activity to ensure documentation is appropriate to support expected reimbursement and that risk adjustment coding indicators are accurately documented. The ideal candidate possesses extensive knowledge of CPT, HCPCS, modifiers, and coding guidelines, notably for surgical service lines, and demonstrates the ability to prepare and analyze quality and financial reports. A thorough understanding of legal and compliance issues as they pertain to clinical documentation is also required.

Requirements

• Minimum five years of progressive professional coding or CDI experience.
• Working knowledge of risk adjustment coding and clinical conditions impacting quality outcomes is required.
• Strong understanding of surgical service documentation and coding.
• Certified Professional Coder (CPC), Certified Risk Adjustment Coder (CRC).

Nice To Haves

• Previous experience training clinicians is preferred.

Responsibilities

• Development of Professional Billing training material surrounding annual CPT/ICD10 code updates.
• Assists in the research, review and development of new service offerings to determine documentation and reimbursement requirements.
• Works with Revenue Cycle and IS stakeholders to identify top denials attributed to coding issues. Generates communications to physicians, service line leaders, and physician network leadership to address the underlying issues surrounding the denials. Develops training materials as needed to minimize future denials. Assists MLHC CBO with appeals.
• Works in collaboration with MLHC Clinical Quality teams including Medical Directors to provide feedback and education to providers on risk adjustment (e.g. HCC) coding patterns and opportunities.
• Collaborates with MLH Compliance and HIM Departments to ensure MLH’s provider documentation expectations are reinforced.
• Develops and administers training presentations to clinical providers, Quality Directors, and coders.
• Develops appropriate education and focused re-training based upon the data trend analysis.
• Conducts and documents regular education programs on correct coding and documentation, using applicable standard professional tools.
• Makes appropriate programs available to physicians, Quality depts, CDI Reviewers, Coders and others as needed.
• Maintains electronic attendance rosters and documentation.
• Makes programs available on-line to the extent available with MLH technology.
• Analyzes CPT billing patterns, Work queue and denial volumes to identify areas of improvement.
• Monitors coding changes and risk adjustment score changes that could significantly impact data quality and/or revenue.
• Demonstrates positive interpersonal skills.
• Is a role model for staff for attendance, punctuality, and professional appearance.
• Displays excellent communication skills, makes group presentations with confidence.
• Collaborates with MLHC network leadership on provider and employee remediation efforts.
• Develops and maintains up-to-date policies and procedures in conjunction with Coding and CDI Managers.
• Reports operational issues that could affect the quality of documentation or coding. Collaborates with Revenue Cycle, Compliance and HIM management on operational improvement.

Benefits

• Tuition Reimbursement (eligible for up to $6,000 per year based upon Full or Part Time status)
• Employee discounts to various activities, services, and vendors
• Free employee parking

What This Job Offers

• Job Type: Full-time
• Career Level: Director