Manager - Professional Clinical Coding

MaineHealth Accountable Care Organization; Scarborough (ME); Remote; USD 60,000 - 100,000; Full time

Job summary

An innovative healthcare organization seeks a dedicated leader to manage the Revenue Integrities Clinical Data Section. This fully remote position involves overseeing the coding and abstracting of medical records, ensuring compliance with regulatory requirements, and preparing statistical analyses for financial and billing purposes. The ideal candidate will possess advanced knowledge in health record administration, effective leadership skills, and a commitment to fostering an inclusive environment. Join a team that values collaboration and supports your career growth while making a meaningful impact on healthcare delivery.

Benefits

Paid Parental Leave

Flexible Work Policy

Student Loan Assistance

Training and Education

Well-being Resources

Qualifications

• Advanced education in health record administration preferred.
• Certification in RHIA/RHIT, CCS, CPC required.
• Minimum two years supervisory experience needed.

Responsibilities

• Manage coding and abstracting of medical records for outpatient claims.
• Prepare statistical analysis of medical records data.
• Ensure compliance with regulatory agencies.

Skills

Leadership

Communication

Coaching

Planning

Motivation

Education

Health Record Administration/Technician/Science Bachelor's/Associate Degree

Tools

EPIC

Encoder Software

CDI Programs

Job description

Location: Scarborough, ME
Facility: MaineHealth Corporate
Schedule:
Job Category: Management/Leadership
Req #: 4724
Date Posted: Jan 27, 2025

Fully Remote
This position manages Revenue Integrities Clinical Data Section, which is accountable for: coding and abstracting the medical records of Provider Based practice outpatient practice clinic claims; preparing statistical analysis of medical records data; compiling, analyzing and summarizing data from medical records into various formats. The output of this Section is used for: meeting hospital licensure requirements; financial and billing purposes, which includes the identification and determination of appropriate reimbursement under inpatient and outpatient prospective payment systems; maintenance of acceptable accounts/receivables and Pre A/R levels; compliance with internal and external regulatory agencies, such as Quality Improvement Organizations, the Centers for Medicare & Medicaid Services, and The Joint Commission.

Required Minimum Knowledge, Skills, and Abilities (KSAs)

1. Education: Advanced education which should include communication and mathematical/statistical skills and/or extensive knowledge in organization, research and analysis normally acquired through the completion of Health Record Administration/ Technician /Science Bachelor's/Associate Degree program, preferred.
2. License/Certifications: Certification in one of the following areas required: RHIA/RHIT, CCS, CPC. Skilled in ICD10 diagnosis and CPT coding and knowledge of Provider Based Billing practices.
3. Experience: A minimum of two years prior successful supervisory experience required; Experience with EPIC, claim edit processes, encoder software and CDI programs, preferred.
4. Knowledge: Full working knowledge of medical information and revenue cycle systems; Grouper and Severity of Illness Systems; medical record systems, medical terminology, anatomy, physiology, pathophysiology, microbiology, and pharmacology; State, Federal and Joint Commission requirements pertaining to medical records; Provider Based payment systems, preferred.
5. Abilities: Demonstrated abilities to correctly interpret and apply Federal regulations and PRO requirements in the interpretation of various billing guidelines (i.e., medical necessity, resident supervision policies, correct coding initiative, etc.). Ability to direct concurrent and retrospective coding reviews and provide physician education, required.
6. Skills: Effective skills in leadership, communications, coaching, planning, motivation, and establishing effective working relationships at all levels of staffing in the organization.

Additional Information
With a career at any of the MaineHealth locations across Maine and New Hampshire, you’ll be working with health care professionals that truly value the people around them – both within the walls of the organization and the communities that surround it.
We offer benefits that support an individual's needs for today and flexibility to plan for tomorrow – programs such as paid parental leave, a flexible work policy, student loan assistance, training and education, along with well-being resources for you and your family.

MaineHealth remains focused on investing in our care team and developing an inclusive environment where you can thrive and feel supported to realize your full potential. If you’re looking to build a career in a place where people help one another deliver best-in-class care, apply today.

MaineHealth policy requires all care team members to be vaccinated, including for Covid-19 and influenza, subject to eligibility for medical or religious exemptions which can only be granted in compliance with applicable law.

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