Coding Manager

Position Overview:

Reporting to the Director of Coding Compliance, the Coding Manager is responsible for oversight of all coding operations for Commercial facilities utilizing the Central Billing Office (CBO).  The Coding Manager ensures the CBO maximizes the collectability of the services performed, that policies and practices support operational quality, efficiency, and compliance. This role is responsible for fielding questions from clients in a timely manner by researching authoritative sources and providing accurate answers. Additionally, this role will assist and lead a variety of audit projects working closely with the leadership team to report findings and suggest improvements to internal processes by analyzing data.

Responsibilities:

• Communicate effectively with all levels of the organization: Management, Client Sites and Staff
• Perform coding audits on outside vendor to ensure integrity of revenue cycle
• Solve any coding discrepancies identified
• Assist in coding related denial resolution, provide coding related information needed to accomplish Accounts Receivable and billing goals
• Work with implementation team to identify and solve coding variances when new sites are transitioned
• Coordination and planning of all external coding audits, management of outcomes
• Ensuring that all client coding is up to date through effective management of coding vendor relationship and processes
• Planning and deployment of coding education throughout organization
• Communication of relevant coding related changes/information to client sites and staff
• Develop and deploy coding presentations to client sites semi-annually for updates
• Maintains professional and technical knowledge by attending educational workshops; reviewing professional publications; establishing personal networks; participating in professional societies.
• Completes quality audits to ensure CBO employees are providing the highest quality of work.
• Ensure claims are adjudicated in compliance with provider contract parameters, member demographic information, and service level requirements through random and targeted claim reviews.
• Compile data, perform audit, interpret and report back results to the leadership team.
• Assist in establishing, updating, communicating, and training new and existing policy and procedures.
• Review and analyze medical records to identify diagnoses, procedures, and services provided
• Ensure coding accuracy and compliance with coding guidelines, regulations, and payer requirements.
• Manage daily coding email queues providing responses within 3 business days.
• Additional duties as assigned.

Requirements:

• RHIA, RHIT, CPC, COC, CASSC, or CCS certification required.
• Associates degree in relevant field preferred or combination of equivalent of education and experience
• At least 2-5 years of RCM leadership in Orthopedic/Pain management/ Ambulatory Surgery Center highly preferred.
• Experience with HST, Vision, SIS Complete, AdvantX and/ or Waystar is helpful.
• Must have knowledge of AMA, CMS, and CPT coding guidelines.
• Knowledge of ICD-10-CM, medical terminology, anatomy & physiology.
• Sound judgment and strong skills with respect to interpersonal relations, critical thinking, problem solving and analysis
• The ability to communicate effectively, both verbally and in writing, with internal and external clients
• Must be able to multi-task and handle competing priorities while meeting or exceeding deadlines.
• Ability to work independently and as a member of the team with the ability to identify and resolve complex client problems.
• Must possess positive attitude to enhance a cooperative and energetic work environment.
• Excellent knowledge of health care billing procedures, documentation, regulations, payment cycles and standards.
• High School Diploma or equivalent.