Manager Professional Billing Coding Operations - Remote

bmc; United States; Remote; USD 110,000 - 170,000; Full time

Job summary

Boston Medical Center seeks a Manager of Professional Billing Coding Operations to lead the PB Coding Operations team, overseeing coding staff and ensuring accurate CPT/HCPCS/ICD-10 coding. You will partner with the Coding Education Team to improve provider performance and drive ongoing training.

This remote role involves quality assurance reviews, denial analysis, and feedback to providers and departments to support revenue cycle goals and ensure compliance with coding rules and payer

Responsibilities

• Oversee and supervise professional billing coding staff.
• Validate accuracy of CPT, HCPCS and ICD-10 coding.
• Analyze denials and perform root-cause analysis.
• Provide feedback and education to providers and departments.
• Conduct quality assurance reviews of records and coding performance.
• Develop and implement coding education and audits.
• Ensure compliance with Official Coding Rules and payer guidelines.

Job description

POSITION SUMMARY:

Responsible for the operational functions of the Professional Coding Operations team for BUMG. Plays a strategic role in validating the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non -physician practitioners. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers. Supervises professional billing coding staff. Partners with Coding Education Team to identify trends in coding practices and assists with developing feedback and education to providers. Reviews coding denials to resolve and identify trends and provides feedback to providers and departments. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly, including coding changes and updates. Oversees coding operations to ensure organizational goals are being met. Partners with the Coding Education Team to design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines. Oversees the coding edits and denials and ensures compliance with payer guidelines. The Manager, PB Coding Operations is responsible for supporting coding related, RAC, other external coding reviews, and denials related to coding.

Boston Medical Center (BMC) is more than a hospital.

It´s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all-and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet - an integrated health care delivery systems that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.

Position: Manager Professional Billing Coding Operations - Remote

Department: BUMG Corporate PBO General

Schedule: Full Time

ESSENTIAL RESPONSIBILITIES / DUTIES:

• Primary responsibilities under the direction of the Director, PB Coding Operations:
  
  
  
  • Coding support
    
    
    
    • Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures. Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems. Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing.
    
    
    • Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. Consults with appropriate medical staff to clarify medical record information.
    
    
    • Maintains productivity standards set forth in Departmental Policies and procedures.
    
    
    • Serves as contact for professional billing coders regarding missing/incomplete information to allow for accurate billing in a timely manner.
    
    
    • Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.
    
    
    • Assists in orienting new personnel in department coding procedures.
    
    
    • Monitors all coding ques to ensure productivity is being kept on target.
    
    
    • Performs other duties as needed.
    
    
    • Review and respond to coding questions.
    
    
    • Ensure billed service is being accurately coded.
    
    
    • Perform random chart audits.
    
    
    • Perform analysis of benchmarking profiles.
    
    
    • Provide continual coding updates.
    
    
    • Research coding issues that arise.
    
    
    • Codes diagnoses and procedures from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems.
    
    
    • Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.
    
    
    • Reviews charts for documentation and signature.
    
    
    
    
  
  
  
  


• General
  
  
  
  • Responsible for the day-to-day management of the PB Coding Operations Team.
  
  
  • Duties include managing, developing and mentoring a group of certified professional coders.
  
  
  • Other responsibilities include interviewing, orientation, training and preparing evaluations; responsible for hiring, terminating and disciplining personnel as necessary.
  
  
  • Establishes staffing scheduling and assigns workloads and projects in accordance with appropriate volume increases and decreases.
  
  
  • Assists with codin