ESSENTIAL FUNCTIONS

Manages the day-to-day operations of the assigned Coding departments to optimize performance and quality levels while ensuring most efficient use of resources.
Monitor all aspects of billing activity and initiate appropriate corrective measures as needed. Communicates performance data and associated actions plans to Senior Leadership.
Identifies and implements processes to achieve key revenue cycle metrics including but not limited to Posted Charges, Suspended Claims, Rejection Percentage, and Denial Percentage.
Analyze large volumes of data and provide financial analysis and regularly presents trends, movements, and status to Senior Leadership.
Review coding work queues on a regular basis to ensure that workloads are distributed evenly, and that the department metrics are being met.
Resolve complex patient, physician, and other issues when necessary.
Develop and implement policies and procedures for designated areas; evaluate new systems and methods and recommend changes as necessary.
Supervises, trains, and orients and evaluates performance over assigned staff.
Understands and stays abreast of payer requirements and changes within the industry. Provides training and oversight to staff to assure that these requirements are executed.
Attends administrative meetings and participates in committees as requested.
Maintains comprehensive knowledge of 3rd party billing requirements and reimbursement principles. Also maintains comprehensive working knowledge of payor contracts and ensures that payors are billed according to contract provisions.
Conducts regular meetings with staff to discuss third party reimbursement methodologies. Provides direction to staff on changes in managed care reimbursement and expectation of changes in insurance guidelines.
Keeps abreast of compliance regulations, standards, and directives regarding governmental/regulatory agencies and/or third-party payers. Ensure communication and education of such to the Billing department as well as other Revenue Cycle Leaders.
Research and resolve discrepancies in a timely manner.
Support and comply with all company policies and procedures.
Must be able to meet deadlines given by Senior Management.
Works with sensitive and confidential materials and must be able to exercise discretion.
Provide tools for Team Leads and Supervisors to sustain, develop, enforce, and report department standards and metrics; recommend actions for improvement.
Review and update systems with annual coding, RVU and diagnostic coding changes/updates/additions.

EDUCATION

Bachelor’s degree or an equivalent combination of education and experience

EXPERIENCE

Minimum five years’ experience in a leadership role within a billing department in healthcare revenue cycle operations, coding and medical terminology.
Required experience includes professional and facility coding.
Preferred experience working with multiple physician specialties, ASC and hospitals.
Previous supervisory experience and strong leadership skills with an ability to motivate with a positive attitude that impacts others in a positive way.

REQUIREMENTS

AAPC Certification
Demonstrated successful healthcare revenue cycle leadership experience
Experience analyzing and trending financial data
Excellent written and verbal communication and presentation skills
Excellent critical thinking, troubleshooting, and analytical skills
Excellent interpersonal skills including conflict management
Experience working in Excel (advanced formulas, pivot table)
Well organized and able to meet deadlines
Excellent attention to details

Job Type: Full-time

The CORE Institute | HOPCo

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Manager Coding and Compliance