Manager Medical Group Coding Quality

At Virtua Health, we exist for one reason – to better serve you. That means being here for you in all the moments that matter, striving each day to connect you to the care you need. Whether that's wellness and prevention, experienced specialists, life-changing care, or something in-between – we are your partner in health devoted to building a healthier community. 
 
If you live or work in South Jersey, exceptional care is all around. Our medical and surgical experts are among the best in the country. We assembled more than 14,000 colleagues, including over 2,850 skilled and compassionate doctors, physician assistants, and nurse practitioners equipped with the latest technologies, treatments, and techniques to provide exceptional care close to home. A Magnet-recognized health system ranked by U.S. News and World Report, we've received multiple awards for quality, safety, and outstanding work environment.

In addition to five hospitals, seven emergency departments, seven urgent care centers, and more than 280 other locations, we're committed to the well-being of the community. That means bringing life-changing resources and health services directly into our communities through our Eat Well food access program, telehealth, home health, rehabilitation, mobile screenings, paramedic programs, and convenient online scheduling. We're also affiliated with Penn Medicine for cancer and neurosciences, and the Children's Hospital of Philadelphia for pediatrics.

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Job Summary:

Responsible for clinical reimbursement quality by ensuring that Virtua Medical Group’s coded data reflects the clinical information documented by clinicians.  Responsible for management and implementation of coding quality and audits, education and training, standards development, etc. for CPT, ICD-10-CM, and HCPCS.  Responsible for managing the annual external clinician audit process (medical staff and advanced medical providers), including re-audits, and education.  Responsible for developing, implementing, and maintaining policies and compliance plan for physician coding and abstracting.  Responsible for human resource management for audit team.

Position Responsibilities:

Internal Coding Quality Audits: Designs audit tools to monitor coding and abstracting quality and compliance; performs audits; provides timely feedback to staff, management, and physicians; implements improvement measures.  Manages and performs special audits to facilitate quality improvements and compliance. 

Annual External Coding Audit:  Ensures all clinicians are audited by an external vendor on an annual basis, coordinates coding education for all clinicians, and manages clinician re-audit process.

Serves as a subject matter expert for daily professional fee coding inquiries. Works with various stakeholders on answers to questions regarding application of coding guidelines for individual accounts.  Provides feedback in form of emails, calls, one on one meetings, group meetings, and presentations.  Responsible to stay abreast of all coding changes and updates. Manages communication and training of those changes.

Designs education for staff and clinicians in correlation with audit findings, using best practice coding methods. 

Human Resource Management:  Interviews, hires, coaches, counsels, disciplines, terminates, evaluates, recognizes, and mentors VMG Auditors & Educators.  Performs and approves payroll function/process. Monitors and reports on productivity and quality standards.

Policies and Procedures: Develops policies and procedures on coding, data abstraction, and audit standards.  Documents and enforces policies and procedures for VMG and provides feedback to appropriate leaders and/or staff.  Recommends changes to policies, procedures, and documentation requirements to ensure appropriate reimbursement.

Position Qualifications Required:

Required Experience:

Expert knowledge of professional fee coding required (ICD-10, CPT, HCPCS, and other reimbursement methodologies), including compliance and audit requirements.

2 years of supervisory experience preferred or 5-7 yrs of combined professional fee coding and auditing experience.

Excellent organizational, communication, and customer service skills.

Ability to utilize Information Systems, including electronic health records, effectively

Ability to make sound decisions independently and provide guidance to others.

Epic experience preferred.

Required Education:

Bachelor’s or Associate’s degree in Health Information Management/other related field, and/or 5-7 years of professional fee coding and auditing experience.

Training / Certification / Licensure:

Certification as a CPC and/or CCS-P required. 

Certification as a CPMA preferred.