The Manager, Coding Compliance, performs outpatient coding and billing audits and other projects related to coding compliance. Completes audit assignments and other projects in fulfillment of Ethics and Compliance Department work plans. Educates facility staff on proper clinical coding, documentation and billing standards and rules.
- Performs outpatient audits projects with minimal supervision.
- Demonstrates a thorough understanding of complex coding, reimbursement and health information management processes and auditing principles related to outpatient settings.
- Demonstrates an understanding of the UB-04, detailed bill and detailed Remittance Advice as related to charging and payment for outpatient services.
- Communicates with Department leadership and facility management teams regarding outpatient coding and billing issues and regulations
- Keeps informed regarding current coding regulations, professional standards, and Company/Department policies and procedures, and effectively applies this knowledge.
- Implements audit engagements including scheduling and undertaking audit fieldwork with minimal supervision.
- Analyzes medical records and coding and documentation information, identifies issues, reaches conclusions, and proposes strategies for resolution of coding issues.
- Has a working knowledge of chargemaster functions.
- Prepares working papers, reports and memoranda regarding coding compliance matters and audit results.
- Develops, organizes and maintains spreadsheet data or worksheets related to coding and documentation compliance.
- Coordinates scheduling to meet Department work plan requirements while maintaining audit accuracy
- Communicates effectively with facility personnel and Company leadership regarding coding and documentation compliance matters.
- Manages specific area of expertise including research, keeping abreast of changes, and informing/educating other outpatient coding compliance team members.
- Manages audit engagements including managing his/her individual time, scheduling work and monitoring the progress of assigned audits.
- Serves as a trusted business advisor by providing facility personnel with professional advice and best practice information regarding coding and billing compliance.
- Mentors staff and other Department personnel at the request of Department leadership.
- Provides input and guidance in the development and review of detailed audit programs and reports to improve audit effectiveness and efficiency
- Assists in developing and executing Department educational plans related to coding matters, working in conjunction with the Director of Compliance education.
- Reports to Company leadership including the Chief Compliance Committee on matters related to coding compliance, as directed by Department leadership.
- Maintains coding expertise in outpatient coding and billing, including research, keeping updated on regulatory changes, and informing/educating other coding compliance team members.
- Undertakes continuing education to maintain technical coding, HIM, auditing and management skills consistent with the Company and Department’s professional development requirements and individual credentials.
- Works with Department leadership to improve Department processes, and to enhance overall compliance posture of the overall organization
- Maintains confidentiality in accordance with legal obligations and the Company Code of Conduct and the Code of Ethics for Healthcare Professionals adopted by the Health Care Compliance Associate.
- Demonstrates outstanding work ethic, and works cooperatively with all team members and clients with a can-do spirit and team attitude
- Performs other Department duties as assigned
Associate or Bachelor degree in Health Information Management, other appropriate degree, or equivalent experience:
HIT or RHIA (or eligibility), or equivalent experience.
One or more of the following certifications (or eligibility):
- 2 years of hospital coding or equivalent experience
- Ability to travel 20% of the time.
Instructions for Resume Submission: