Coding and Compliance Manager, Eugene, OR
Coding and Compliance Manager
Job Tracking ID: 512611-574065
Job Location: Eugene, OR
Job Type: Full-Time/Regular
Date Updated: December 28, 2017
Starting Date: ASAP
Number of Openings: 1
PURPOSE OF POSITION: Coordinate all Coding operations and activities for Oregon Medical Group. Hire and manage Coding Team members. Create and implement departmental procedures and policies. Direct and communicate established standards of performance to employees, ensure adequate staff coverage to meet production needs at all times, monitors production reports and audits work for accuracy. Work with Executive Medical Director to create and maintain comprehensive tracking and management tools for providers for the HCC process. Correlate activities, processes and HCC results/metrics to evaluate outcomes. Work with other departments to meet organizational goals. Train physicians and other staff regarding documentation, billing and coding. Provide feedback to physicians regarding documentation practices.
SUPERVISION RECEIVED: Chief Financial Officer and indirectly to Executive Medical Director
SUPERVISION EXERCISED: Coder I, Coder I – Certified and Coder II
TYPICAL PHYSICAL DEMANDS: Requires sitting for prolonged periods of time and some bending, stooping and stretching. Requires hand-eye coordination and manual dexterity necessary for the operation of basic office equipment such as computer terminal and telephone. May be required to lift up to 25 pounds. Requires hearing in normal acuity range and eyesight correctable to 20/20. Must have adequate manual dexterity to write legibly and perform required procedures. Requires the ability to work quickly under stress.
TYPICAL WORKING CONDITIONS: Work is performed in an office environment. Involves frequent contact with staff, patients and the public. Work may be stressful at times.
EXAMPLES OF DUTIES: (This may not include all of the duties assigned).
- Manage all coding activities and billing compliance for the facility.
- Create strategic plan as it relates to implementation of departmental policies and procedures. Responsible for implementation of processes as they relate to the strategic plan.
- Provide analysis to monitor correct coding by the coding staff, and monitor coding related denials to identify trends and maximize facility reimbursement.
- Work with other system interfaces to ensure appropriate coding.
- Develop weekly/monthly reports which monitor claims and coding trends.
- Monitor the quality and productivity of work in the department, ensuring that all procedures and documentation are in compliance with commercial and government insurance companies, as well as specific payer and audit guidelines.
- Oversee training of staff and monitoring of backlogs.
- Manage staff and serves as a role model through professionalism by actions, response, and behavior.
- Develop and manage departmental budget.
- Responsible for hiring, training, coaching, reviewing job performance and counseling all direct report staff.
- Develop and maintain good working relationships with all managers of OMG.
- Attend meetings as required and maintains strictest confidentiality.
- Perform other duties as assigned.
- Responsible for educating and keeping management informed on current changes in regulations as related to coding, billing and documentation.
- Ensures staff is educated on Coding guidelines and HCC Coding.
- Apply coding principles consistent with government standards, payer specific guidelines of the health plans and Oregon Medical Group policy. Monitor workflow of coders including turnaround time of daily charges capture.
- Assist physicians and other clinic staff with coding and billing-related questions.
- Develop and present coding presentations and training to large and small groups of clinicians, practice managers and coders – developing training to fit specific needs.
- Provide resources to educate and assist providers with HCC processes.
- Maintain Oregon Medical Group Billing and Coding desktop reference manual as well as ordering and distributing coding reference material.
- Interface with operational and clinical leadership to assist in identification of operational and clinical best practices in maximizing recapture rates, understanding clinical suspects and monitoring of appropriate clinical documentation and quality coding.
- Assist with the creation of EMR forms to make sure documentation requirements are met for all services.
- Manage all billing and coding compliance for the facility.
- Manage the facility’s Confidential Disclosure Hotline, by either investigating billing and coding issues or routing HIPAA concerns to the appropriate contacts.
- Provide general healthcare compliance training to all new hires for the facility.
- Research and update policies when new healthcare laws and regulations are implemented.
- Meet with physician-elected Compliance Officer on a regular basis to update them on all investigations, concerns and new laws.
- Function as an active member of the OMG Compliance Committee.
- Write and file all incident reports pertaining to the facility’s billing and coding compliance.
- Correspond with OMG’s healthcare attorney when concerns or incidents for additional help are needed.
- Review incoming work and set priorities for completion to expedite workflow.
- Assign and distribute work and review progress of work to ensure deadlines are met.
- Authorize appropriate overtime. Approve work and vacation schedules.
- Explain rules, policies and procedures.
- Interview and hire.
- Update and train employees on new work procedures or operations. Determine training needs and recommend training programs.
- Evaluate staff performance and initiate corrective action plans as necessary.
- Prepare position descriptions and work plans; resolve work-related problems such as performance, workload, and scheduling.
- Develop and revise work procedures and systems to assure efficient workflow or reduce operating costs. Coordinate work flow activities with other units.
- Compile statistics and prepare a variety of reports (e.g., personnel staffing, space and equipment needs, productivity, expenditures).
- Design or revise forms used to complete work activities. Inventory equipment and supplies, recommend purchase of equipment and authorize orders for general supplies.
- Answer questions and provide information about policies, procedures, and services to staff.
- Work with individuals to identify problems and offer solutions or answers.
Relationships with Others: In person, telephone, or written contact on a regular basis with staff, and customers to provide or request information, respond to questions and complaints, resolve problems, and explain policies and procedures. The Manager receives general supervision from an administrative superior who assigns and reviews the progress of work through weekly informal conferences and reviews completed work for accuracy, compliance with deadlines, and conformance to company policies and procedures, and personnel policies and procedures. Strong interpersonal and negotiation skills. Demonstrated ability to work effectively in a team environment.
Experience and Skills:
PERFORMANCE REQUIREMENTS: In depth knowledge and experience of evaluation and management documentation guidelines and coding, chart auditing, coding compliance policies and procedures and reimbursement practices. Knowledge of clinic operating policies. Skill in using computer and 10 key calculators. Ability to examine documents for accuracy and completeness. Ability to prepare records in accordance with detailed instructions. Ability to work effectively with physicians, patients and co-workers. Ability to communicate clearly, both verbally and in writing.
EDUCATION: Equivalent of a high school diploma. Bachelor’s Degree in Health Care Administration or related field preferred.
EXPERIENCE: Five years’ experience in a health care operations setting with three years management experience.
CERTIFICATION: Active coding certification through AAPC or AHIMA required. Must obtain compliance certification through AAPC or HCCA within one year of employment. Certification in HCC coding such as CRC, or willingness to obtain within 6 months of employment.