Job description
Job Description:
Under the general supervision of the Senior Coding Manager (PB-PCS) provides oversight and direction of System-wide Professional Coding to implement and maintain standardized processes and compliant coding guidelines. Coordinates processes and/or third-party contracts regarding coding. Oversees, assigns coding staff and/or participates in reimbursement audits across the System. Works with other System departments to ensure a cohesive team effort in addressing coding and/or coding compliance matters. Provides oversight and supervision of and has responsibility for assigned staff.
Duties and Responsibilities
- Monitors and ensures coding productivity and timeliness.
- Provides PCS operational oversight as needed; and monitors daily work activities including work queues and dashboards.
- Develops and coordinates educational and training programs regarding elements of professional coding standardization and compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including PCS coding staff, physicians, billing personnel and ancillary departments.
- Coordinates final approval for coders to work from home, including management of Off Site/Home Contracts to ensure compliance and full understanding of all HIPAA regulations regarding working from home, and having home access to the WellSpan Network.
- Establishes and communicates to appropriate coding staff a defined daily process for monitoring and working professional charges
- Assists the Senior Coding Manager (PB-PCS) in the development, implementation and analysis of protocol standards/work methodology consistent with industry trends and departmental objectives.
- Keeps the Senior Coding Manager (PB-PCS) informed of all coding-related issues
- Conducts internal investigation of changes in coding practices or reports of other potential problems pertaining to coding, communicating findings to Senior Coding Manager (PB-PCS) Corporate Compliance.
- Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity across Professional Coding, and reports to the Senior Coding Manager (PB-PCS)
- Represents PCS on various committees, as assigned
- Acts on behalf of the Senior Coding Manager (PB-PCS), as needed, and serves as a liaison between PCS and other departments to ensure a consistent flow of information.
- Assists with system conversion activities as needed
- Provides PCS operational supervision (in absence of Director), as needed.
- Receives and investigates professional coding compliance violations and communicates this information to the Senior Coding Manager (PB-PCS) and the Corporate Compliance Officer.
- Ensures the appropriate dissemination and communication of all regulations, policy and guidelines changes. Works with WellSpan entities to ensure coding software is up to date, facilitate fee analysis and make recommendations regarding the addition of new codes and fees.
- Serves as a resource for Compliance Office, department managers, staff, physicians, and administration to obtain information on accurate and ethical coding and documentation standards, guidelines and regulatory requirements.
Qualifications
- Notes:
- Other combinations of formal education, training and experience may be considered.
- Minimum Experience:
- 5 years of coding and reimbursement experience
- Minimum Education:
- Associate's Degree in a health services discipline
- Minimum Field Of Expertise:
- Inpatient/outpatient coding systems and coding compliance
- Required Certification:
- Certified Procedural Coder (CPC) or Certified Coding Specialist-Physician (CCS-P)
- Skills:
- Extensive knowledge of ICD-10-CM and CPT coding principles and guidelines; Extensive knowledge of reimbursement systems, as well as federal, state and payer-specific regulations and policies pertaining to documentation, coding and billing; Extensive knowledge of Best Practice Standards of Coding and identification of reliable compliant reference sites and/or materials; Strong managerial, leadership, and interpersonal skills; Excellent written and oral communication skills; Excellent analytical skills
- Management Experience: Supervisory experience required
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