Manager, Professional Medical Coding (Remote)

Cape Cod Healthcare•Hyannis, MA

2d•Remote

About The Position

The Manager, Professional Medical Coding oversees the daily operations of the Physician Coding Department, managing professional coding staff and vendors and ensuring compliant, accurate coding and clinical data abstraction. The role monitors coding performance, EPIC work queues, accounts receivable and DNFB metrics, denials, and applicable coding KPIs, and develops action plans to address performance gaps. It also supports coding and billing issue resolution, quality improvement and compliance initiatives, and internal and external coding audits. The manager works extensively with physicians, practice managers, MACC leadership, nursing staff, patient caregivers, HIM/Coding Management, Practice Management, Professional PFS, IT, vendors, and other stakeholders. The role develops documentation-improvement and physician-education strategies, provides coding and reimbursement guidance, creates and delivers training, evaluates education and performance-improvement plans, and reports physician-specific documentation performance measures. The manager maintains current knowledge of coding and reimbursement rules and supports continuous process improvement. This is a remote position. A bachelor’s degree or equivalent combination of education and experience and a current CCS or CPC certification are required. A master’s degree and AAPC CEMC or CPMA certification are preferred. The role requires at least five years of progressive professional coding experience across multiple specialties, including auditing and/or management, and one to two years of supervisory experience with professional coding staff.

Requirements

Bachelor’s degree or equivalent combination of education and experience.
Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) certification.
At least five years of progressive experience in professional coding across multiple specialties, including auditing and/or management experience.
One to two years of supervisory experience with professional coding staff.
Strong working knowledge of medical terminology, anatomy and physiology, and reimbursement requirements.
Comprehensive understanding of Evaluation and Management coding and specialty coding.
Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.
Understanding of complex corporate relationships and ability to influence within such an environment.
Demonstrated ability to use PC-based office productivity tools such as Microsoft Office.
Demonstrated goal-oriented thinking and operational and organizational skills.
Ability to create training materials and deliver training in area of expertise, including large-group presentations.
Ability to communicate with and present to a wide variety of internal and external users, including senior management, physicians, vendors, and consultants.
Ability to work under pressure, manage multiple initiatives concurrently, work independently, set priorities, and meet deadlines.

Nice To Haves

Master’s degree.
CEMC (Certified Evaluation and Management Coder) or CPMA (Certified Professional Medical Auditor) certification through the AAPC.

Responsibilities

Ensure compliant coding operations and quality coding and abstraction of clinical data in accordance with established policies, regulations, procedures, and standards.
Manage staff performance related to coding, communication with practices, and resolution of claim edits and denials.
Manage professional coding staff and vendors and facilitate resolution of coding issues.
Work with the Professional PFS department to resolve coding and billing issues and monitor, review, and resolve denial issues.
Monitor daily DNFB accounts receivable and other departmental metrics and benchmarks to achieve fiscal goals; consistently monitor EPIC work queues.
Confirm supervisory staff consistently maintain performance and monitoring processes.
Define, implement, and monitor strategies to improve documentation.
Develop physician education strategies with the validation team and MACC leadership to promote complete and accurate clinical documentation.
Develop and report physician-specific documentation compliance performance measures to medical staff and other departments.
Collaborate with physicians, practice managers, MACC leadership, nursing staff, and other patient caregivers to improve the quality and completeness of care documentation and coding.
Oversee daily operations of the Physician Coding Department.
Administer education and training, evaluate the effectiveness of education or performance-improvement plans, and provide feedback to the Director.
Work with HIM/Coding Management and Practice Management staff to assess practitioners’ and staff’s coding-process strengths and recommend improvements.
Serve as a resource to physician practices and staff on ongoing coding education; answer practitioner and management questions about coding and reimbursement, researching and recommending solutions as needed.
Assist in developing, implementing, and evaluating educational programs for coding applications and processes.
Provide input to Coding Management for employee evaluations.
Develop and administer quality improvement and compliance initiatives, including internal and external coding quality audits.
Manage applicable coding KPIs and define and implement action plans when performance does not meet expectations.
Assess direct reports’ performance consistently and provide feedback to recognize effective performance and support improvement.
Ensure coding employees and vendor staff perform coding functions in compliance with established policies, processes, and compliance programs.
Support IT in testing modifications and troubleshooting issues for EPIC and systems that feed into it.
Maintain current working knowledge of coding and reimbursement rules, regulations, trends, and developments, and share relevant knowledge with staff.
Use sound judgment and strong organizational, independent problem-solving, and analytical skills.
Consistently provide service excellence to patients, family members, visitors, volunteers, and coworkers.
Challenge current practices, identify process-improvement opportunities, and present recommendations and solutions to management; participate in and promote CCHC Pillars of Excellence and continuous improvement.
Perform other job-related duties and assignments as requested.