Coding Services Manager
One Community Health
Responsible for planning, organizing and managing coding, clinical documentation and clinical data quality oversight activities of the revenue cycle at One Community Health, a Federally Qualified Health Center (FQHC). Working coding manager responsible for daily coding of outpatient medical, dental and behavioral health records using the most accurate and appropriate ICD-10-CM, AMA CPT & HCPCS Level II codes in accordance with Centers for Medicare & Medicaid Services (CMS) compliance and regulatory coding guidelines, best practices in the industry, and policy and procedures. Responsible for auditing outpatient records to support a complete and accurate clinical picture, evaluation and management visits (E/M), comorbidity and complication capture rates, risk adjustment (RA) and hierarchical condition category (HCC) coding, billing, mandated reporting, and quality measures. Works closely in partnership with the Revenue Cycle Manager and assists in improving the revenue cycle and reducing claims rejections by providing oversight to the organization’s Coding Services and coding staff. Develops Coding Services Department and coding and clinical documentation policies, procedures, EPIC EHR workflows and systems for the organization. Effectively lead a team of two as well as be a team member; ability to embrace change, make independent decisions and multi-task with high attention to detail. Uses effective communication skills to provide ongoing feedback, training and continuing education to the coding staff, providers, and medical, dental, and behavioral health staff and revenue cycle team.
- Embrace the philosophy, mission, and values of OCH.
- Adhere to the guidelines and procedures of OCH.
- Performs daily coding of encounters, meets productivity standards; responsible for coding 25% of daily encounters Completes provider querying, follow-up and submits encounters for timely billing.
- Maintains regular reports (code changes, captured revenue, claims denials, productivity, etc.)
- Acts as direct manager of coding staff/services. Coding subject matter expert and keeps abreast of ICD-10, CPT, and HCPCS II codes, Coding Clinic, HCC & risk adjusted coding, CMS transmittals and official coding guidelines; advise all staff of coding guidelines and requirements. Responsible for maintaining RHIT/RHIA and coding credentials.
- Responsible for the day-to-day management, training and evaluation of the coding team. Manages workflows to optimize allowable reimbursement. Responsible for cross-training coding specialists on different coding areas for back-up coverage. Develops, sets and monitors productivity standards. Manages the work queues and follows up on missing documentation.
- Responsible for auditing outpatient records to support a complete and accurate clinical picture, evaluation and management visits (E/M), comorbidity/complication capture rates, risk adjustment (RA) and hierarchical condition category (HCC) coding, billing, mandated reporting, and quality measures.
- Completes audits of coding specialists coding assignments and provider/staff documentation and code assignment.
- Collaborates with Revenue Cycle Manager and Billing staff, reviews current billing workflows and processes with Revenue Cycle Manager to identify: Optimization opportunities resulting in cleaner claims, redundancies, why they happen and how they can be avoided and automation opportunities.
- Understanding the uniqueness of Federally Qualified Health Center (FQHC) and the impact on billing and coding, providing consistent communication and feedback to the Revenue Cycle Manager and billing staff for educational purposes
- Develops OCH Coding guidelines, workflows, program policies & procedures, process improvement and provides education & training to coding staff, providers, clinical & non-clinical staff.
- Builds communication with providers, Epic site specialists, data analysts, clinical staff
- Proficient in all aspects of the computerized systems in the coding area and educates all staff on existing software and any upgrades or enhancements,
- Educates & collaborates with clinical staff about clinical documentation improvement (CDI) and official coding guidelines and compliance
- Works with the revenue cycle team, Epic Specialist, providers, and quality improvement team and risk management team to identify, review and resolve coding issues related to billing, regulatory requirements, clinical documentation, and UDS, HRSA, and CCO clinical measure reporting.
- Participates in process improvement through identification of provider or coder trends (documentation and coding) as well as workflow evaluations.
- Other Duties as assigned or needed
Knowledge, Skills, and Abilities
- Develops the Coding and Clinical Documentation Improvement (CDI) program and integrates with the billing and revenue cycle program. Works collaboratively with the Revenue Cycle Manager to meet CMS coding guidelines, payor and regulatory agency requirements, and compliance regulations. Builds coding clinical database with emphasis on Hierarchical Condition Categories (HCC), risk adjusted coding and value-based care
- Effectively manages resources, meets performance goals and budget targets. Understands OCH’s billing and revenue cycle systems and uses them effectively. Effectively manages vendor relationships to maximize contributions
- Acts as a change leader with ability to provide leadership throughout the change process. Engages staff in the entire process and develops commitment for sustaining change
- Ability to see and understand whole systems and how elements within systems relate. Works collaboratively with others to use appropriate system strengths, knowledge and cooperation to improve performance
- Develops organizational talent, ability to recruit, retain and develop high performing individuals aligned with OCH’s goals and values. Completes performance reviews and development plans for all direct reports
- Able to prioritize and organize work according to multiple and, at times, competing timelines
- Able to meet timelines for team and organizational goals safely and with high level of quality
- Strong written and oral communication skills
- Successful relationship management skills involving multidisciplinary teams in a diverse, multicultural environment.
- Able to use initiative and good judgment to resolve problems and challenges
- Able to work effectively in an operation that expects and promotes teamwork and have demonstrated ability to work with ambiguity.
- Able to inspire trust and confidence, and communicate effectively with internal and external audiences
- Able to work independently, work with multiple projects and maintain a high degree of professionalism and confidentiality.
- High level computer skills, including use of Microsoft Office applications: Word, Excel, Outlook, Epic, and other systems
- Knowledge of and compliance with HIPAA regulations
- Knowledge of customer service and workplace safety
- Able to work in a team environment, to work independently, and/or be self-directed
- Identify learning needs and goals and design a plan to meet them.
- Able and willing to work in a dynamic and changing community health care environment
- Minimum of 5 -7 years direct management experience for all aspects of a healthcare facility Coding Program/Services and supervising/managing outpatient and physician-based coders including performing coder evaluations and initiating corrective action
- Minimum of (5) years outpatient and physician-based coding experience as a certified coder (CCS-P, CCS, or CPC)
- At least (5) years working with billing/finance department
- Minimum of 3 years EHR experience
- Understanding of Medicaid reimbursement, Medicare, commercial insurance, self-pay and third Payor contracts
- Demonstrated teaching experience in developing educational plans for a coding department, providers and clinical staff
- Demonstrated literacy with Microsoft Office software
- Strong communication and project management skills; demonstrated ability to effectively lead a team as well as be a team member; ability to embrace change, make independent decisions and multi-task with high attention to detail
- Knowledge of multi-disciplinary procedures, workflow, and data flow process in a health care organization
Preferred Knowledge, Skills & Abilities
- Internal locus of control
- Expectation to excel and be part of a high functioning team
- Understand and work within a systems perspective
- Understand and work with HRSA requirements and expectations
- Use of Epic Electronic Health Record (EHR)
- Federally Qualified Health Center (FQHC) experience
- Behavioral Health coding experience
- Experience in HCC and risk adjusted coding
Education & Certification Required:
- Bachelor’s Degree with a valid Registered Health Information Administrator (RHIA) certification through American Health Information Management Association (AHIMA) Health Information Management program or
- Associates Degree with a valid Registered Health Information Technician (RHIT) certification through American Health Information Management Association (AHIMA) Health Information Management program AND
- Valid RHIT certification or valid RHIA certification with one of the following:
- 1. Certified Coding Specialist Physician Based (CCS-P) – valid AHIMA certification
- 2. Certified Coding Specialist (CCS) – valid AHIMA certification
- 3. Certified Professional Coder (CPC) – valid American Academy for Professional Coders (AAPC) certification
We have a generous benefits package which includes medical, dental & vision coverage. Company-paid long-term disability. This includes a 401k plan with company match. Up to 200 hours of paid time off per year and 6 paid holidays for full time staff.
Instructions for Resume Submission:
To apply and submit resume visit One Community Health website: https://www.onecommunityhealth.org/careers/