Senior Billing & Coding Compliance Program Manager

Kroger • Cincinnati, OH

1d

About The Position

Responsible for leading, implementing, and monitoring billing and coding compliance plans/projects, and analyzing coding quality and accuracy. Serve as coding compliance subject matter expert and develop education and training. Collaborate with stakeholders to support Kroger Health billing/coding activities. Demonstrate the company's core values of respect, honesty, integrity, diversity, inclusion, and safety.

Requirements

• High School Diploma or GED
• 5+ years coding auditing and medical coding experience
• AAPC/AHIMA certification
• Thorough knowledge of Medicare reimbursement guidelines and medical terminology
• Demonstrated coaching and influencing skills
• Knowledge/understanding of healthcare compliance industry and federal laws/regulations
• Attention to detail and ability to maintain a high degree of confidentiality
• Excellent presentation, verbal, and written communication skills
• Ability to identify opportunities for process improvement and implement solutions
• Highly self-motivated with ability to work independently and with a team, prioritize, and handle multiple responsibilities to meet deadlines
• Strong analytical, organizational, computer, and excel skills

Nice To Haves

• Bachelor's Degree
• Any compliance experience

Responsibilities

• Lead education, policy, and resource development/maintenance, and provide training support for coders, accounts receivable, practitioners, dietitians and clinic/pharmacy associates
• Research guidelines/regulations such as Medicare transmittals/Manuals, LCDs, NCDs and CMS/OIG guidelines pertinent to assessments
• Adhere to AAPC and/or AHIMA ethical coding standards, and remain abreast of changes to coding standards/regulations
• Serve as a Kroger Health resource to improve coding and documentation processes both internally and externally
• Responsible for coding/documentation reviews and audits to assess compliance and accuracy with ICD-10/CPT/HCPCS codes, modifiers, updated coding standards, and other regulatory guidelines/requirements
• Evaluate quality of clinical documentation to assess quality of data being submitted and/or reported, chart review trends, and audit findings
• Identify and communicate emerging issues and trends to stakeholders
• Coordinate external coding compliance audits, including sample selection, communications with external auditor and internal stakeholders, reviewing/analyzing audit results, and coordinating audit completion and follow-up
• Manage follow-up activities related to audits/reviews, ensure corrective action/remediation occurs (including internal follow-up audits), and prepare audit reports
• Liaison with coding vendors and internal coders
• Evaluate processes within area of responsibility to recommend and participate in process improvement initiatives
• Direct investigation of escalated coding, billing, and documentation compliance matters
• Perform or assist with assigned projects as required to maintain workflow and to meet schedules and quality requirements
• Participate in variety of meetings and work groups to integrate activities, communicate issues, obtain approvals, resolve problems and maintain specified level of knowledge pertaining to new developments, requirements, and policies
• Perform other related duties as assigned
• Must be able to perform the essential job functions of this position with or without reasonable accommodation

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees