Manager Professional Coding Integrity (FT salaried)

Purpose of the Position

The primary purpose of this position is to manage the overall operations of the professional coding integrity team, including the overall performance of the professional coding program to ensure consistency, accuracy, compliance, optimal reimbursement and reduced denials.

Duty 1: Provide Management Oversight

• Provide management oversight of the professional coding integrity team and related functions with the primary objective to support the optimal performance of the professional coding program, which includes proper ICD-10 / CPT code assignment to ensure compliance with applicable regulatory standards, maintain high level of quality and consistency, optimize reimbursement, and reduce denials.
• Effectively communicate and solicit input from team and other impacted areas to promote a collaborative and innovative team environment, translates BVHS’s Mission, Vision and Values into front-line action.

Duty 2: Perform and/or Provide Oversight to Managerial Administrative Support Functions

• Facilitate the recruiting and hiring process, training & education of associates, monitor appropriate staffing levels, payroll, performance evaluations, recognition and reward, disciplinary follow up as appropriate, establish/monitor performance metrics, monitor completion of organization requirements.
• Aids Director in developing and monitoring department budget and strives to control departmental costs.

Duty 3: Active Engagement to Support Organization Cascading Goals Initiative

• Engage in organization cascading goals initiative, including idea boards, associate engagement, service excellence and contribution margin.

Duty 4: Recommend and Implement Professional Coding Compliance Plan

• Recommends and implements professional coding compliance plan and related policies and procedures to promote compliant and consistent coding practices, inclusive of ICD/CPT code assignments which are reflective and supported by clinical documentation.
• Makes recommendations for modifications to the plan in anticipation of changing organizational needs (e.g. implement a new service line) and/or in response to revised regulatory requirements (e.g. IPPS and OPPS annual updates, CPT Assistant, Coding Clinic, etc.).
• Ensures appropriate dissemination of information and education to ensure coding integrity team and/or any other pertinent individuals or departments remain current on coding compliance plan/policies and procedures.

Duty 5: Provide Oversight of Quality Audit Program

• Oversees and monitors the results of quality audits performed by Professional Coding Auditor and Educator and supports the resolution of identified opportunities through the creation and implementation of an action plan.
• Monitors third party payer audits and assists, as necessary, defending takebacks and in the appeal process related to code assignments and evaluate opportunities to reduce coding denials.
• Ensures relevant decisions related to coding practice are documented in policies or procedures to promote ongoing standardization and consistency.

Duty 6: Develop and Track Key Metrics

• Develops and tracks key metrics to measure overall performance of team operations.
• Analyzes data to determine opportunities for improvement and implement follow up or action plans to address.
• Evaluates workflows and processes to address issues that may be causing delays or for opportunities to continue to optimize operational efficiencies.
• Strives for continuous performance improvement through monitoring industry best practices and evaluating / implementing tools and processes to enhance work performance and outcomes.

Duty 7: Collaborate with Corporate Compliance Department

• Collaborates and maintains open communication with the corporate compliance department in audits or initiatives related to professional coding and charge processes.
• This may include involving team in coding reviews in response to an investigation or potential compliance risk, conducting charge-related research, assisting to develop an audit tool or interacting with third party consultants conducting a compliance audit.

Duty 8: Collaborate with Medical Providers and Clinical Leadership

• Collaborates and maintains open communication with the medical providers and clinical leadership on coding and documentation practices with a primary focus to maintain compliant practices which accurately reflects reporting of coded data and provider metrics.
• Foster positive relationships with providers and clinical teams to create a spirit of partnership and alignment of organizational goals.
• Provide feedback and education to providers / clinical team on opportunities identified.

Duty 9: Attend and Participate in Education and Conferences

• Regularly attend and actively participate in relevant education / conferences, organizational meetings and continuing education programs as offered in order to remain current with organizational and industry changes and best practice.
• Communicate and disseminate information to other departments as applicable.
• Provide training and educational support/opportunities to the Revenue Integrity Team.

Duty 10: Understand Federal, State and Third Party Coding Guidelines

• Demonstrate superior understanding of federal, state and third party coding guidelines related to coding practices.
• Collaborate with Revenue Integrity Department, as needed, to implement revisions to charge/billing regulations, including annual IPPS and OPPS updates.

Duty 11: Maintain Systems Knowledge and Support

• Knowledgeable of systems utilized to support operations, including Cerner, 3M Encompass, Craneware, Quadex and workflows and provide support to super users as needed to ensure optimal utilization of systems and operational workflows.

Required Qualifications

• A Bachelor’s degree in a related field including but not limited to, Health Information Management (HIM) or 4+ years’ experience from which comparable knowledge and abilities have been acquired.
• CPC certification required or achieved within 9 months of hire date.
• Medical terminology and Anatomy & Physiology.
• Knowledge of ICD10/DRG/Coding Clinic, CPT/HCPCS/APC/CPT Assistant/Modifiers.
• Knowledgeable of revenue cycle workflows, including information and charge workflows throughout the health system.
• Advanced technical aptitude, mastery of desktop applications including Microsoft Office Suite (Excel, Powerpoint, Word), internet, electronic health records, and encoder.
• Strong problem solving and analytical skills, ability to manage project tasks and timelines.
• Self-directed.
• Must possess positive service-oriented and interpersonal skills; strong communication, including written and verbal presentation skills, required.
• Ability to manage controversial situations in a professional way and demonstrate sound judgment and reasoning skills.
• Ability to effectively lead a team incorporating the BVHS’s Mission, Vision and Values into the culture.
• Maintain effective connectivity and collaboration between all members of the team, including onsite and remote associates.
• A valid driver's license is required (if you do not have a valid Ohio driver’s license you must obtain one within 30 days of your residency in the state).
• You must also meet BVHS's company fleet policy and insurance company requirements, and any other requirements that may be required to operate a vehicle.

Preferred Qualifications

• Certification in HIM (RHIA or RHIT)
• Other relevant certifications, including CEMC, CANPC or CPB
• Knowledge of Clinical Documentation Improvement concepts