Under the supervision of the Director of Reimbursement, the Coding Manger's primary duties include supervising the work of staff who review, interpret, code, and abstract medical records information according to standard classification systems. The incumbent performs most advanced medical records coding and abstraction duties as well as data quality reviews, and prepares complex reports as required. The incumbent also performs other related duties as assigned, including assisting the Medical Revenue Manager in ensuring all policies and procedures for the department are upheld (e.g., registration policies, etc.).
DUTIES AND RESPONSIBILITIES
· Directly supervises Medical Claim Processors, Medical Billing and Coding Processor, and Credentialing Specialist.
· Supervises and performs a wide range of activities pertaining to the review and coding of inpatient and outpatient medical record information.
· Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.
· Assures physicians and direct staff are educated on AMA and CMS Guidelines and accurate coding documentation services.
· Performs data quality reviews on outpatient encounters to validate the ICD-9-CM, the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments; checks for missed secondary diagnoses and/or procedures; ensures compliance with outpatient reporting requirements.
· Monitors medical visit code selection against facility-specific criteria for appropriateness; assists in the development of such criteria as needed.
· Monitors and manages the productivity and performance of assigned employees including reporting daily/weekly/monthly department metrics to Senior Management.
· Directs and coordinates credentialing of physicians for billing purposes.
· Streamlines processes for claim submission.
· Develops and recommends policy applicable to the medical service revenue cycle process.
· Works effectively with other management in problem-solving and subsequently in developing, implementing, and evaluating new policies and procedures in areas of shared responsibility.
· Recommends and implements new or improved systems which will enhance or expedite work.
· Prioritizes and assigns work to employees and initiate corrective measures to resolve problems including scheduling or adjusting overtime requirements as necessary.
· Selects, trains, develops, appraises, and counsels support staff personnel.
· Creates performance guidelines for supervised staff.
· Tracks and requests outstanding encounters.
· Coordinates with Health Center Directors processes for receiving and correcting problem encounter forms.
· Selects, assigns, and trains subordinate technical and clerical staff; directs, monitors and evaluates work; reviews and makes decisions regarding leave requests; initiates and implements disciplinary action as needed; assists with and promotes the recruitment and retention of qualified staff as assigned.
· Responds to general requests for information.
· Utilizes procedures and policies.
· Maintains strict confidentiality regarding confidential conversations, documents, and files.
· Notifies director immediately of any discrepancies.
· Performs other duties as assigned.
· Bachelor's degree in Business or related area required. Master's degree in Business preferred.
· CPC is required, CPC-H, CPC-P and CEMC preferred.
· Minimum of 10 years successful experience in a management position with focus on health care coding and billing is required.
· Successful management experience of (over 10-person) department required.
KNOWLEDGE & EXPERIENCE REQUIRED BY THE POSITION
· Ability to give presentations and interact with many different levels of UHC leadership.
· Maintains knowledge of current and required coding certifications as appropriate; may perform the most technical complex and difficult coding and abstraction work.
· Familiarity with medical front end registration processes required.
· Must be computer literate with extensive working knowledge in Microsoft Word and Excel.
· Must demonstrate ability to be a team leader.
· Ability to work in a team-oriented environment and interact well with individuals with diverse ethnic and cultural backgrounds and needs.
· Good oral, written, and telephone communication skills.
· Must attend a "train the trainer" course and at least one management training class per year.
· Must attend at least one health care finance or coding training course per year.