Senior Manager-Professional Coding Services

Job Description:

Under the general supervision of the Director-Health Information Management-Professional Coding Services (HIM-PCS), directs, plans, organizes and controls the activities and functions related to systemwide professional coding. Provides direct supervision of the assigned Manager(s) and Team Lead(s) of professional coding. Oversees, assigns coding staff and/or participates in reimbursement audits across the system. Coordinates processes and/or third parties regarding coding. Monitors and addresses coding compliance issues and trains workforce in coding compliance matters. Works with other system departments to ensure a cohesive team effort in addressing coding and/or coding compliance matters.

Duties and Responsibilities

1. Establishes, coding productivity and timeliness.
2. Responsible for the professional coding operations and monitors daily work activities including work queues and dashboards.
3. Develops and coordinates educational and training programs regarding elements of professional coding standardization as well as Outpatient Prospective Payment System Billing (OPPS) and compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including PCS Managers, Team Leads and coding staff, physicians, billing personnel and ancillary departments.
4. Establishes and communicates to the appropriate staff a defined daily process for monitoring and working professional charges.
5. Conducts trend analyses to identify patterns and variations in coding practices and documentation, and communicates findings to necessary parties.
6. Assists the Director of Professional Coding Services in the development, implementation, and analysis of protocol standards/work methodology consistent with industry trends and departmental objectives.
7. Keeps the Director of Professional Coding Services informed of coding related issues.
8. Conducts internal investigation of changes in coding practices or reports of other potential problems pertaining to coding, communicating findings to Director of Professional Coding Services and Corporate Compliance.
9. Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity across HIM-PCS.
10. Represents HIM-PCS on various committees, as assigned.
11. Acts on behalf of the Director of Professional Coding Services as needed and serves as a liaison between HIM-PCS and other departments to ensure a consistent flow of information.
12. Assists with system conversion and upgrade activities as needed
13. Provides HIM-PCS operational supervision (in absence of Director of Professional Coding Services), as needed.
14. Receives and investigates professional coding compliance violations and communicates this information to the Director of Professional Coding Services and the Corporate Compliance Officer.
15. Ensures the appropriate dissemination and communication of all regulations, policies, and guidelines changes. Works with WellSpan entities to ensure coding software is up to date, facilitates fee analysis and makes recommendations regarding the addition of new codes and fees.
16. Serves as a resource for Coding Managers, Coding Team Leads, Compliance Office, department managers, staff, physicians, and administration to obtain information on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.

Qualifications

• Notes:
  • Other combinations of formal education, training and experience may be considered.

• Minimum Experience:
  • 5 years of coding and reimbursement experience

• Min Field of Expertise: Inpatient/outpatient coding systems and coding compliance

• Minimum Education:
  • Associate Degree in a health services discipline

• Required Certification:
  • Certified Procedural Coder (CPC) or Certified Coding Specialist-Physician (CCS-P)

• Skills:
  • Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines; Extensive knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing; Extensive knowledge of Best Practice Standards of Coding and identification of reliable compliant reference sites and/or materials; Strong managerial, leadership, and interpersonal skills; Excellent written and oral communication skills; Excellent analytical skills; Epic proficiency
  • Mgmt experience required