Manager, Outpatient Coding

Overview

Manager, Outpatient Coding

40 hours per week, day shift

JOB SUMMARY: Oversees the coding and billing functions for a large department or division, including supervision of employees, to ensure appropriate and timely reimbursement. Oversees and trains coding staff. Designs, implements, and documents coding policies and processes. Conducts audits and evaluates operations to identify opportunities for improvements. 

EDUCATION/EXPERIENCE: Associate's degree required with five years' experience in medical coding including one year in a supervisory role; or, an equivalent combination of education and experience. Bachelor's degree preferred. 

LICENSURE, CERTIFICATION, and/or REGISTRATION: Coding certification including Certified Coding Specialist (CCS) or Certified Coding Specialist Physician (CCSP) required. RHIA or RHIT preferred. ICD-10 training certification or complete within first year of employment. 

ESSENTIAL FUNCTIONS: 

1. Oversees and supervises on- and off-site coding personnel by assuring that the proper quality and quantity of work is performed based on CPT, ICD and regulatory guidelines and policies. Provides appropriate training and instruction to staff, answering questions regarding proper procedures, and assigning and coordinating work. 

2. Supervises and coordinates various personnel functions, including hiring, merit recommendations, promotions, transfers, and vacation schedules. 

3. In collaboration with Coding and Clinical Documentation leadership, provides appropriate direction, education and training to medical coding staff, residents and physicians and other departmental billing providers. Working with Coding Enterprise leadership, ensures that Coding staff are trained properly. 

4. Maintains a current knowledge of CPT and ICD coding guidelines as well as related insurance reimbursement issues. Performs research (e.g., articles, CMS website, etc.) as needed to obtain information on proper coding and billing policies and procedures.

5. Maintains liaison with agencies, coding organizations, and consultants. Distributes coding, reimbursement and clinical documentation information to faculty and staff pertinent to their specialty. 

6. Functions as a liaison between the department/division and Patient Financial Services. 

7. Collaborates with Reimbursement Services as needed regarding the department/division's fee schedule. 

8. Performs routine quality audits of staff members' (including contract staff) coding and billing work. Functions as a key member of the departmental compliance committee. 

9. Leads staff with handling complex coding charge review and edit issues. Assists physicians and other billing providers with charge capture in WakeOne being able to guide physicians and others billing providers. 

10. Assures timely and accurate coding of patients charts for department/division related to billing of Facility inpatient and hospital and operative services based on defined revenue cycle metrics from management. Responds to coding and billing questions from coding staff, physicians and other parties such as corporate revenue cycle. 

11. Works with Coding Enterprise leadership, Patient Financial Services staff, Departmental/Division leaders and others to identify trends related to denials and clinical documentation improvement needs. Creates processes in collaboration with Enterprise Coding leadership and Clinical Documentation Improvement program to provide feedback to clinicians related to documentation improvements related to ICD-10 and denials. 

12. Assures compliance with federal regulatory and The Joint Commission guidelines pertaining to medical coding. Requires superior knowledge of coding guidelines and practices with the ability to code all types of patient encounters accurately and completely utilizing the ICD-CM and CPT-4 classifications systems. 

13. Maintains current policies and procedures and updates those as needed to comply with coding standards. Consults with management and corporate compliance regarding compliance concerns. 

14. Performs other related duties incidental to the work described herein. 

SKILLS/QUALIFICATIONS: Detailed knowledge of CPT and ICD coding Coding knowledge specific to department/division may be required Supervisory experience Working knowledge of reimbursement procedures and practices Working knowledge of North Carolina carrier practices and guidelines may be required. (e.g., Palmetto Medicare, NC Medicaid and other payers.) 

WORK ENVIRONMENT: Clean, well-lit, comfortable office setting