Coding Manager

University of Toledo Physicians offers competitive pay and benefits including: 403B, Pension, health and tuition waiver at UT.

POSITION SUMMARY

Manager Centralized Charge Control provides leadership and vision for the planning and management of University of Toledo Physicians coding and revenue cycle services. Oversees the day-to-day operational management for hospital(s) and physician services for centralized charge control. Responsible for motivating staff to achieve the highest levels of performance, working in conjunction with all key stake holders to secure and maximize revenue.  Manages charge capture for complex service lines and/or for Provider services outside of the clinic and oversight for all charge revenue generating departments.  Optimizes staff performance and revenue through process redesign, policy/procedure implementation, communications, continuing education and professional development activities, staff empowerment and feedback. Serves on various committees and workgroups and is a key advisor to the executive team in support of corporate objectives related to health information management, coding, and reimbursement.

ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES

1. Manages the operation of the clinical coding from all revenue generating service lines within UTP, including inpatient/outpatient coding, clinical data abstraction, report writing, and HIPAA compliance.  Maintains the confidentiality of all patient/staff records.

2. Reviews billing requirements and develops and maintains policies and procedures that support clinical coding and compliance, and ensures appropriate coding of services while mitigating any compliance risks in a timely and efficient manner.

3. Collaborates with the medical staff and departments to ensure the quality and consistency of clinical documentation.

4. Tracks risk exposure incidences and calculates the financial impact based upon approved processes designed to resolve/reduce compliance risks and reports them to the Director of Revenue Cycle. 

5. Coordinates audits of coding and documentation practices and initiates continuous quality improvement activities to ensure compliance with regulatory and accreditation requirements.

6. Prepares and conducts education and training programs to keep staff and departments current on coding, reimbursement, compliance and regulatory changes and procedures. 

7. Continuously assesses functional work processes, initiating changes as needed to improve efficiency and effectiveness, and moves the clinical coding functions toward industry best practices. Actively participates with teams involved with process improvements.

8. Manages employees (direct reports) including, work schedules, counseling, conducting performance appraisals, interview, etc. and provides instruction to staff and management as necessary. Provides mentoring to lead staff in performing like functions.

9. Identifies and develops focused approach to ensure appropriate charge capture:

1.  Ensures proper charge capture practices are implemented consistently cross the  organization
2. Develops and implements operational processes to ensure timely and accurate charge entry for supported services in an efficient and effective manner that assist in the reduction of charge capture related denials
3. Conducts quality (at minimum quarterly) and productivity reviews (at minimum monthly) to ensure appropriate and accurate charging practices are in effect
4. Oversees continuing education efforts for staff as needed based upon billing and charging processes guided by coding, compliance and regulatory guidelines specific to their service. This is done through staff assessment and planning appropriate methods to meet developmental needs.
5. Takes appropriate action based upon quality and productivity reviews to return the team’s performance to best practice standards including operational, scheduling and personnel changes as needed
6. Works and collaborates with clinical leadership as needed to make certain all revenue cycle related needs for a clinical department are met and that we continually improve the flow of patient information and resolve issues or inconsistencies with coding, charge capture, compliance and data/information.
7. Works with all areas of the revenue cycle process including coding and billing to resolve issues as needed

10. Routinely evaluates and documents the revenue capture process for each department and identified process improvements.

11. Serves as a resource on HIM issues including information security, storage and retrieval, confidentiality, record retention, authorship and authentication of health record documentation, standardization of medical vocabularies, and use of classification systems.

12. Monitors and reports key financial and operational indicators related to coding and utilizes information to improve performance.  

13. Monitors and remains current on all coding, reimbursement, compliance, and privacy guidelines through review of CMS and payer websites/newsletters for changes impacting charging, coding and billing.

14. Utilizes automation and computer systems effectively to maintain privacy and maximize productivity, quality, and customer service.

15. Provides feedback in a prompt, direct and positive manner; mentors and coaches colleagues to ensure positive outcome. Provides counseling and/or conflict resolution regarding unresolved performance issues, demonstrating effective use of the disciplinary process.

16. Analyzes and displays data in meaningful formats; develops and communicates policies/procedures and other business documentation; manages and conducts special studies and prepares management reports.

17. Maintains communication with leaders on an ongoing basis to review performance targets as well as other projects as defined by the CFO and the Director of Revenue Cycle.

18. Performs other duties as assigned.

REQUIRED QUALIFICATIONS 

• Education: Associate’s Degree (Business Administration, Health Information or related field) or an equivalent combination of education and experience.
• Skills: Three years of professional coding supervisory experience, including working knowledge of medical terminology, correct coding principles of CPT/HCPCS and ICD10, NCCI edits and payer policies. Strong analytical and statistical skills. Excellent written and verbal communication skills, change management skills and the ability to effectively manage multiple priorities simultaneously.
• Years of Experience: Minimum of three (3) years of management experience in a multi-facility, integrated health care delivery system.
• License and/or Certification: RHIA, RHIT, CCS, CCS-P, CPC/COC coding certificate required. CEMC or CPMA required, or obtained within one year of hire. 

PREFERRED QUALIFICATIONS 

• Education: Bachelor’s Degree (Business Administration, Health Information or related field).
• Skills: Five years of clinical and/or acute coding experience. AthenaHealth and EPIC software experience desired. Strong experience in acute care and/or professional fee coding, charge capture, error and denial management, process improvement and other key functions related to revenue and reimbursement integrity.
• Years of Experience: Five years
• License and/or Certification: RHIA, RHIT or other auditing credentials preferred.  
• Other Job Qualifications: Knowledge and experience of Revenue Integrity and Charge Capture experience in an acute care and/or physician practice setting. Strong knowledge of CPT, UB Revenue Codes, ICD-10-CM codes and related regulatory and compliance guidelines. Ability to understand and interpret complex issues and clinical processes and recommend improvements.

WORKING CONDITIONS

Primarily inside in well-lighted, well-ventilated areas.

Primarily sedentary in nature with occasional lifting of small objects weighing approximately 10 pounds; sitting; standing; walking; talking and hearing.

Must be able to execute all terms and conditions set forth in the University of Toledo Physicians, LLC Employee Handbook, including, but not limited to:

a. Works in a safety-conscious manner which ensures that safe work practices are used in order not to pose a risk to self or others in the workplace.

b. Complies with company policies and procedures and local, state, and federal regulations.

c. Adheres to policy on Substance Abuse.

d. Interacts in a tactful, diplomatic, and humanistic manner with patients, visitors, and co-workers to provide a safe and effective environment that ensures self-respect, personal dignity, and physical safety of everyone.

e. Maintains a dependable attendance record and adheres to standards of the dress code.

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics. 

Equal Opportunity Employer/Drug-Free Workplace