Manager, Professional Medical Coding (Remote)

Cape Cod Healthcare Inc; Hyannis (MA); Remote; USD 100,000 - 120,000; Full time

Job summary

Cape Cod Healthcare seeks a seasoned Manager of Professional Medical Coding (Remote) to lead the coding function, audits, and quality initiatives. You will supervise staff and vendors, ensure compliance with internal policies and governing agencies, and partner with HIM/Coding leadership to optimize documentation and reimbursement.

You will collaborate with physicians, practice managers, and MACC leadership to drive high-quality coding and timely issue resolution, while monitoring KPIs and

Qualifications

• Bachelor’s degree required or equivalent combination of education and experience. Master’s degree preferred.
• Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) required.
• Minimum of five years of previous progressive experience in multiple specialties of Professional Coding including experience in auditing and/or management.
• Possess strong working knowledge of medical terminology, anatomy and physiology, reimbursement requirements.
• One to two years supervisory experience of professional coding staff.
• Requires comprehensive understanding of Evaluation and Management Coding and Specialty coding.
• Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.
• Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
• An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
• Demonstrated ability to use PC based office productivity tools (e.g. Microsoft Office) is required.
• Demonstrated goal-oriented thinking, operational and organizational skills.
• Demonstrated ability to create training materials and deliver training in area of expertise including large group presentations.
• Ability to communicate with and present to a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.
• Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines.

Responsibilities

• Manage compliant coding operations and ensure quality coding and abstraction of clinical data.
• Oversee staff performance and communication with practices; resolve denials and coding issues.
• Supervise professional coding staff and vendors; facilitate issue resolution.
• Coordinate with the Professional PFS dept to resolve coding/billing issues and denials.
• Monitor DNFB and other department KPIs; oversee EPIC work queues.
• Ensure supervisory staff maintains performance and monitoring processes.
• Define and monitor strategies for improving documentation.
• Develop physician education strategies with validation team and leadership.
• Report performance measures to medical staff and departments.

Skills

Leadership

Communication

Problem solving

Regulatory knowledge

Education

Bachelor’s degree

CCS or CPC certification

Master’s degree

Tools

Microsoft Office

EPIC knowledge

Job description

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Thepayrange displayed on each job posting reflects the anticipated range for new hires. A successful candidate’s actual compensation will be determined after taking factors into consideration such as the candidate’s work history, experience, skill set, and education. This is not inclusive of the value of Cape Cod Healthcare’s benefits package (if applicable), which includes among other benefits, healthcare/dental/vision and retirement. For annual salaries this is based on full-time employment.

Beware scam interview requests

Cape Cod Healthcare has been made aware of an instance in which a potential scammer has attempted to impersonate CCHC leadership and request chat interviews. Please note this is not our process and we will never direct you to interview solely through web-based chat. For any questions about available job opportunities or to learn more about our interview process please visit our careers page: https://www.capecodhealth.org/careers/

Manager, Professional Medical Coding (Remote) (261009-50007678)

Purpose of Position : Manages professional coding function and corresponding staff. Manages auditing and quality control and improvement initiatives, ensures compliance with internal policies and procedures and governing agencies, and works with HIM/Coding Director to assist with departmental needs and planning.

Description

1. Ensure compliant coding operations quality coding and abstraction of clinical data in accordance with compliance with established policies, regulations, procedures and standards.
2. Manages staff performance as related to coding, communication with practices and resolution of claim edits, denials, procedures and standards as related to Physician Coding.
3. Manage Professional coding staff and vendors performing professional coding and facilitates problem resolution of coding issues
4. Work with the Professional PFS dept to facilitate resolution of coding/billing issues, monitoring, reviewing, and resolve denial issues.
5. Monitor discharged not final billed daily accounts receivable and accounts (“DNFB”) and any other metrics/benchmarks established by the department to achieve established fiscal goals for the department. Consistently monitors all EPIC work queues.
6. Confirm the supervisory staff is consistently maintaining performance, and monitoring processes.
7. Define, implement, and monitor strategies for improving documentation.
8. Develop physician education strategies in conjunction with validation team and MACC leadership to promote complete and accurate clinical documentation.
9. Develop and report performance measures to the medical staff and other departments of physician specific information regarding documentation compliance.
10. Collaborate extensively with physicians, practice managers, MACC leadership, nursing staff and other patient caregivers to improve quality and completeness of documentation of care provided and coded.
11. Oversees the daily operations of the Physician Coding Department
12. Administers education and training necessary, evaluating the effectiveness of the education plan or performance improvement plans, providing feedback to Director.
13. Work collaboratively with HIM/Coding Management and Practice Management staff to assess the strengths of practitioners and staff involved in the coding process and make recommendations for improvements.
14. Serve as a resource to physician practices and staff for ongoing educational needs related to coding. Respond to practitioners and management questions regarding coding and reimbursement, researching as necessary to find answers and make recommendations.
15. Assist in the development, implement and evaluate educational programs for Coding applications and processes.
16. Provides input to Coding Management for employee evaluations.
17. Develop and administer Quality Improvement (QI) and compliance initiatives, including internal and external coding quality audits.
18. Manage to applicable coding Key Performance Indicators (“KPIs”). Define and implement action plans when performance is not meeting expectations.
19. Assess direct reports’ performance on a consistent basis and provide feedback to reward effective performance and enable proactive performance improvement steps to be taken.
20. Ensure coding employees and vendor staff are performing coding functions in a manner which complies with established policies, processes and Compliance programs.
21. Support IT in their efforts to test modifications and troubleshoot issues for the EPIC system and any systems that feed into it.
22. Maintains current working knowledge of all coding and reimbursement rules, regulations, trends and new developments. Responsible for providing knowledge to staff as related.
23. Makes sound judgments; strong organizational, independent, problem solving and analytical skills.
24. Consistently provides service excellence to all patients, family members, visitors, volunteers and co-workers.
25. Challenges current working practices; identifies process improvement opportunities and presents recommendations and solutions to management. Engages and commits to the organization’s culture of continuous improvement by actively participating, supporting, and promoting CCHC Pillars of Excellence.
26. Performs other job-related duties and assignments as requested.

Qualifications

• Bachelor’s degree required or equivalent combination of education and experience. Master’s degree preferred.
• Current CCS (AHIMA Certified Coding Specialist) or CPC (AAPC Certified Professional Coder) required.
• Minimum of five years of previous progressive experience in multiple specialties of Professional Coding including experience in auditing and/or management.
• Possess strong working knowledge of medical terminology, anatomy and physiology, reimbursement requirements.
• One to two years supervisory experience of professional coding staff.
• Requires comprehensive understanding of Evaluation and Management Coding and Specialty coding.
• Strong knowledge of fiscal intermediary and regulatory agency regulations for coding and provider reimbursement.
• Specialty in E&M (CEMC), Certified Evaluation and Management Coder through the AAPC, or CPMA, Certified Professional Medical Auditor through the AAPC preferred.
• An understanding of the psychology of complex corporate relationships, and an ability to influence within such an environment.
• Demonstrated ability to use PC based office productivity tools (e.g. Microsoft Office) is required.
• Demonstrated goal-oriented thinking, operational and organizational skills.
• Demonstrated ability to create training materials and deliver training in area of expertise including large group presentations.
• Ability to communicate with and present to a wide variety of CCHC and external users, including senior management and physicians, as well as outside vendors and consultants.
• Ability to work under pressure and manage multiple initiatives concurrently; must be able to work independently, set own priorities and meet deadlines.

Organization

Primary Location

Massachusetts-Hyannis

Annual/Hourly : Annual - Based on Full Time Employment

Hiring Pay Range : $ 100000 - $ 120000