Manager, Coding Compliance (Hybrid) - Pediatrics

Washington University in St. Louis

6d • Hybrid

About The Position

The Department of Pediatrics is seeking a progressive and skilled Manager of Coding and Compliance. The Manager will oversee the billing cycle and coding function of a large, complex department of 15 clinical division with both inpatient and outpatient coding and coding review involved. Demonstrated excellence in the areas of ensuring coders are coding with accuracy, aligned with regulatory compliance rules, and supporting timeline reimbursement is required. This role serves as the subject matter expert for coding guidelines and must stay current about CMS changes and payor policies as well as any healthcare regulations that may impact coding, billing, and reimbursement. The Manager oversees day-to-day operations of charge capture activities assuring compliance and maximizing revenue and should have deep clinical experience, preferably as a nurse or other clinical staff member. They will manage the coding team that reviews and analyzes clinical documentation and medical records. The Manager should have working knowledge of clinical workflows and the Epic EMR. This leader is responsible for overseeing a team reviewing complex clinical documentation and diagnostic results timely to accurately assign codes for diagnoses (ICD-10), procedures (CPT), and applicable modifiers for services provided to assure maximum reimbursement and regulatory compliance. This leader will also assist in the audit of medical records in order to identify potential problems with the coding and reimbursement process such as edits, denials, appeal letters, and other resolution mechanisms designed to obtain maximum reimbursement in a compliant way.

Requirements

• Bachelor’s degree or combination of education and/or experience may substitute for minimum education.
• Supervisory (5 Years)

Nice To Haves

• AAPC (American Academy of Professional Coders).
• CPC (Certified Professional Coder).
• CCC (Certified Cardiology Coder).
• RHIT (Registered Health Information Technician) from AHIMA.
• Ability to ask questions about conditions/diseases including understanding signs of deterioration and the risks of morbidity.
• Certified Documentation Expert Outpatient (CDEO) - American Academy of Professional Coders (AAPC)

Responsibilities

• Supervise Coding Coordinators to assure hospital based services captured timely and to maximize revenue.
• Directly interact and communicate with faculty on coding, charge capture, compliance and other billing related issues.
• Perform compliance related duties such as review of medical documentation, completion of physician audits and OPBC audits.
• Develop educational material and conducts regular meetings with faculty to determine methods of improving coding and documentation.
• Assure staff attends scheduled training/in-services.
• Keeps abreast of procedures and changes affecting Medicare, Medicaid, HMO, PPO and related health care operations.
• Communicate policies and procedures to staff on billing issues to promote efficient flow of billing process and maximum reimbursement, aligned with compliance.
• Monitor weekly charges and work files.
• Assure weekly completion of hospital missing charge lists and report physician in noncompliance of divisional/departmental missing operative note policy.
• Assure OPBC and Departmental compliance guidelines applied to billed services.
• Serve as compliance liaison to WU Office of Physician Billing Compliance.

Benefits

• Up to 22 days of vacation, 10 recognized holidays, and sick time.
• Competitive health insurance packages with priority appointments and lower copays/coinsurance.
• Take advantage of our free Metro transit U-Pass for eligible employees.
• WashU provides eligible employees with a defined contribution (403(b)) Retirement Savings Plan, which combines employee contributions and university contributions starting at 7%.
• Wellness challenges, annual health screenings, mental health resources, mindfulness programs and courses, employee assistance program (EAP), financial resources, access to dietitians, and more!
• We offer 4 weeks of caregiver leave to bond with your new child. Family care resources are also available for your continued childcare needs. Need adult care? We’ve got you covered.
• WashU covers the cost of tuition for you and your family, including dependent undergraduate-level college tuition up to 100% at WashU and 40% elsewhere after seven years with us.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Number of Employees: 5,001-10,000 employees