Manager, Professional Medical Coding

Cape Cod Healthcare•Hyannis, MA

16h

About The Position

This role is responsible for ensuring compliant coding operations, quality coding, and abstraction of clinical data in accordance with established policies, regulations, procedures, and standards. The Manager oversees staff performance related to coding, communication with practices, and resolution of claim edits and denials. They will manage professional coding staff and vendors, facilitate problem resolution for coding issues, and collaborate with the Professional PFS department to resolve coding/billing issues and monitor denials. Key responsibilities include monitoring daily accounts receivable, discharged not final billed accounts, and other departmental metrics to achieve fiscal goals, as well as consistently monitoring all EPIC work queues. The Manager will ensure supervisory staff maintain performance and monitoring processes, define and implement strategies for improving documentation, and develop physician education strategies in conjunction with the validation team and MACC leadership to promote complete and accurate clinical documentation. They will also develop and report performance measures to medical staff and other departments regarding physician-specific documentation compliance, and collaborate extensively with physicians, practice managers, MACC leadership, nursing staff, and other patient caregivers to improve the quality and completeness of documentation. The role oversees the daily operations of the Physician Coding Department, administers education and training, evaluates the effectiveness of education and performance improvement plans, and provides feedback to the Director. Collaboration with HIM/Coding Management and Practice Management staff is essential for assessing strengths and making recommendations for improvements. The Manager serves as a resource for physician practices and staff for ongoing educational needs related to coding, responding to questions and researching as necessary. They will assist in the development, implementation, and evaluation of educational programs for Coding applications and processes, provide input for employee evaluations, and develop and administer Quality Improvement (QI) and compliance initiatives, including internal and external coding quality audits. The Manager will manage to applicable coding Key Performance Indicators (KPIs), define and implement action plans for underperforming areas, and assess direct reports' performance, providing feedback for improvement. Ensuring coding employees and vendor staff comply with policies, processes, and compliance programs is crucial. Support for IT in testing modifications and troubleshooting EPIC system issues is also required. The Manager must maintain current knowledge of all coding and reimbursement rules, regulations, trends, and developments, and share this knowledge with staff. Strong judgment, organizational, problem-solving, and analytical skills are necessary. The role requires providing service excellence, challenging current practices, identifying process improvement opportunities, and promoting a culture of continuous improvement. Other job-related duties may be assigned.

Requirements

Bachelor’s degree required or equivalent combination of education and experience.
Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) required.
Minimum of five years of previous progressive experience in multiple specialties of Professional Coding including experience in auditing and/or management.
Possess strong working knowledge of medical terminology, anatomy and physiology, reimbursement requirements.
One to two years supervisory experience of professional coding staff.
Requires comprehensive understanding of Evaluation and Management Coding and Specialty coding.
Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.
Demonstrated ability to use PC based office productivity tools (e.g. Microsoft Office) is required.
Demonstrated goal-oriented thinking, operational and organizational skills.
Demonstrated 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 CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.
Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines.

Nice To Haves

Master’s degree preferred.
Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.

Responsibilities

Ensure compliant coding operations quality coding and abstraction of clinical data in accordance with compliance with established policies, regulations, procedures and standards.
Manages staff performance as related to coding, communication with practices and resolution of claim edits, denials, procedures and standards as related to Physician Coding.
Manage Professional coding staff and vendors performing professional coding and facilitates problem resolution of coding issues.
Work with the Professional PFS dept to facilitate resolution of coding/billing issues, monitoring, reviewing, and resolve denial issues.
Monitor discharged not final billed daily accounts receivable and accounts (“DNFB”) and any other metrics/benchmarks established by the department to achieve established fiscal goals for the department. Consistently monitors all EPIC work queues.
Confirm the supervisory staff is consistently maintaining performance, and monitoring processes.
Define, implement, and monitor strategies for improving documentation.
Develop physician education strategies in conjunction with validation team and MACC leadership to promote complete and accurate clinical documentation.
Develop and report performance measures to the medical staff and other departments of physician specific information regarding documentation compliance.
Collaborate extensively with physicians, practice managers, MACC leadership, nursing staff and other patient caregivers to improve quality and completeness of documentation of care provided and coded.
Oversees the daily operations of the Physician Coding Department.
Administers education and training necessary, evaluating the effectiveness of the education plan or performance improvement plans, providing feedback to Director.
Work collaboratively with HIM/Coding Management and Practice Management staff to assess the strengths of practitioners and staff involved in the coding process and make recommendations for improvements.
Serve as a resource to physician practices and staff for ongoing educational needs related to coding. Respond to practitioners and management questions regarding coding and reimbursement, researching as necessary to find answers and make recommendations.
Assist in the development, implement and evaluate educational programs for Coding applications and processes.
Provides input to Coding Management for employee evaluations.
Develop and administer Quality Improvement (QI) and compliance initiatives, including internal and external coding quality audits.
Manage to applicable coding Key Performance Indicators (“KPIs”). Define and implement action plans when performance is not meeting expectations.
Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
Ensure coding employees and vendor staff are performing coding functions in a manner which complies with established policies, processes and Compliance programs.
Support IT in their efforts to test modifications and troubleshoot issues for the EPIC system and any systems that feed into it.
Maintains current working knowledge of all coding and reimbursement rules, regulations, trends and new developments. Responsible for providing knowledge to staff as related.
Makes sound judgments; strong organizational, independent, problem solving and analytical skills.
Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
Performs other job related duties and assignments as requested.