Tidelands Health

Manager Coding and Revenue Integrity- Remote

Posted Date 2 months ago(6/27/2022 9:14 AM)
Job ID
2022-10693
Type
SAL 2 (Full Time Reqular Exempt)
Location
US-SC-Pawleys Island
Shift
Weekday - Days

Responsibilities

Position Summary:

The Coding and Revenue Integrity (RI) Manager is responsible for managing all aspects of day-to-day coding operations, coding education, and RI functions. This includes planning, monitoring, updating, and directing all activities pertaining to coding, coding and RI audits, and charge capture. This role will manage the coding and RI department staff, distribution of work assignments, creation, and oversight of internal audit plans, manage ad hoc reviews; as necessary, disseminate and educate on current coding, billing, and documentation guidelines and related changes, stay abreast of coding and RI technology, establish charge reconciliation procedures, provide oversight and review of business processes related to accurate claims submission and provide education for providers and revenue cycle management (RCM) staff. Additional responsibilities will include managing, tracking, and facilitating policies and procedures for accurate reimbursement in compliance with federal, state, and local laws and regulations. This role will also serve as the RCM representative for growth initiatives that may require input on billing, coding and documentation guidelines, requirements, and regulations

 

Position Responsibilities & Functions

  • Demonstrates through plans and actions the standard of excellence to which all department work is expected, leading, and controlling functional performance, measuring and improving processes, leveraging and automating processes, and continually improving performance.
  • Ensure charge capture is maintained and monitored across the organization, including daily charging to allow timely clean claims processing and avoidance of late charges
  • Builds a collaborative team culture and ensures a high level of employee engagement and satisfaction
  • Assist RI Director with providing operational oversight for all Revenue Integrity functions, including support of clinical departments’ charge capture, coding, and charge reconciliation responsibilities
  • Monitors system reports and monitoring tools to track commercial and government payer denials and appeals related to revenue integrity for both hospital and physician revenue
  • Develops and monitors KPIs related to charging practices and reports metrics to revenue-generating department leadership
  • Plan and implements new procedures, maintains appropriate staffing levels, make budgetary recommendations, and lead coding-related projects.
  • Provides analysis to monitor correct coding by the coding staff, and monitor coding related denials to identify trends and maximize facility reimbursement
  • Responsible for interviewing, hiring, staffing, performance management and development of staff.
  • Counsels and disciplines employees when necessary in accordance with department and/or organizational policies.
  • Develops and maintains the training and education program for new hires and for existing staff.
  • Develops, updates and implements job standards, job duties, departmental policies, and performance appraisals for all areas of responsibility.
  • Participates in audits and appeals with the various insurance carriers. Works closely with Patient Financial Services and Patient Access Departments.
  • In addition, all interactions require an exemplary level of communication skills, leadership skills, teamwork skills, problem solving capabilities, project streamlining and planning abilities, and organizational and time management skills.  Candidates should fully support Tideland Health’s Mission, Vision and Values.

Other duties as assigned - Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee partner for this job. Duties, responsibilities, and activities may change at any time with or without notice.

QUALIFICATIONS

Experience:

Five (5) years of acute care coding experience required.  Minimum of three (3) years of experience in management required. Three (3) years of audit management experience preferred.

 

Education:

Minimum of Associate’s degree in health information management, medical records administration, health services administration or health sciences, or other related field required.

 

Licensure/Certification:

Must have one of the following:
CCS - Certified Coding Specialist
CPC - Certified Professional Coder
RHIA - Reg Health Info Administrator
RHIT - Reg Health Information Technician

 

Required Knowledge/Skills/Abilities:

  • Proficient understanding of revenue cycle operations (front, middle, and back-end revenue cycle)
  • Experience in assisting and identifying learning needs as well as providing education and training designed to support a learning organization.
  • Strong analytical abilities and problem-solving skills
  • Knowledge of reimbursement methodologies including both professional and facility issues and the various data elements associated with the UB and HCFA claim forms required.
  • Knowledge of ICD-10-CM, ICD-10-PCS, CPT/HCPS, MS-DRG, APR-DRG and APC coding guidelines.
  • Knowledge of medical terminology, anatomy, and physiology, a basic knowledge of clinical procedures and diseases, understanding of clinical documentation (such as medical or surgical reports and patient charts).
  • Maintain strict confidentiality, adhering to all HIPAA guidelines/regulations.
  • Ability to work without supervision and communicate effectively with your remote team members.
  • Exemplary self-management skills required.
  • Excellent verbal and written communication skills required.
  • Demonstrated experience with having strong interpersonal communication skills required.
  • Prior experience with interpreting and following detailed policies required.
  • Demonstrated ability to independently think and make judgments in interpreting
  • Ability to organize and set priorities to ensure objectives are met in a timely manner.
  • Ability to adapt to change and handle challenges proactively and with pose.
  • Ability to effectively collaborate with physicians and managerial staff at all levels

Physical Requirements: Light-Medium Physical Agility Test (PAT) Rating

While performing the duties of this job, the employee is frequently (activity or condition exists from 1/3 to 2/3 of the time) required to stand, sit, and walk; frequently to use hands, fingers; and frequently to talk or hear. The employee must exert 15 to 20 pounds of force occasionally (activity or condition exists up to 1/3 of the time), and/or 5 to 10 pounds of force frequently, and/or greater than negligible up to 5 pounds of force constantly to move objects.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.

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