Regional Manager Physician Coding - Risk Mitigation

Fully Remote

Major Responsibilities:

• Ensures that coding practices are standardized system wide and consistent with regulatory requirements. Documents all coding procedures and guidelines in writing and ensures all coding caregivers adhere to them. Identifies opportunities for process and quality improvement based upon analysis and review of current practices.
• Represents Coding Leadership regarding coding practices and issues with other department leadership, vendors, government agencies, and/or clinical providers. Works directly with coding leadership to research and resolve issues. Provides updates to relevant committees and leaders on complex coding issues, current status compared to goals and significant future developments.
• Plans, implements and evaluates training and educational programs based on the department’s goals, regulatory or system changes. Identifies training opportunities and areas of improvement to aid in the development of training courses and reference tools. Ensures all coding caregivers are properly trained to national standards, the information is consistent system wide, and caregivers are regularly informed about external and internal updates, developments and/or issues. May have overall responsibility for the Advocate Aurora Coding Academy.
• Collaboratively develops and implements standardized, organization-wide coding and auditing policies, procedures, guidelines and documentation requirements, ensuring they are compliant with regulatory and accreditation requirements and clearly communicated to the appropriate caregivers.
• Institutes, monitors and holds all coding caregivers accountable to quality and productivity standards. Tracks, analyzes and benchmarks data to peer groups, identifying trends and/or opportunities to improve. Incorporates quality focus areas from the Office of the Inspector General Work Plan. This information is used to develop additional coding education resources. Provides accurate and thorough monthly reports to support progress made in each area of responsibility.
• Establishes, implements and maintains a formalized compliance review and audit process, including the maintenance of all documentation. Ensures audits are conducted and in line with the established coding audit methodologies. Assesses compliance activities by identifying areas of high-risk and mitigating those risks factors system wide. Collaborate with Advocate Aurora Compliance Officers in all aspects of identification, evaluation, reporting and corrective action for any reported or potential risks or violations identified.
• Manage the coding denial and appeal processes. Ensures timely review and response to any third party payer notification of incorrectly coded claims. Develops reporting tools to demonstrate denial rates, appeal rates, success ratio and dollars lost or recovered on a regular basis. Actively involved in designing, maintaining, testing and implementing automation to assist departmental operations to the greatest capacity.
• Manages the timely, accurate review and follow up of professional charge and documentation queries submitted by or on behalf of employed/contracted physicians, APCs, and other clinicians for billing. This includes partnering with Coding Production to resolve charge review, claim edit and insurance coding rejections by getting additional clarification in the service documentation from the clinician. Responsible for directing both Onsite and Specialty Coding Liaison day to day strategies and operations for the system with the assistance of the Coding Liaison Manager and Supervisor team. Serves as a manager level liaison and key point of contact for collaborations with PB Coding leadership, service line Specialty CMOs, Medical Group Administrative Operations and Compliance Leaders, Revenue Cycle Services, Epic Informatics/HIT, Physician Compensation, and ancillary areas to implement and monitor coding queries and clinician documentation quality.
• Performs human resources responsibilities for staff which include interviewing and selection of new employees, promotions, staff development, performance evaluations, compensation changes, resolution of employee concerns, corrective actions, terminations, and overall employee morale.
• Develops and recommends operating and capital budgets and controls expenditures within approved budget objectives.

Licensure, Registration, and/or Certification Required:

• Coding Specialist (CCS) certification issued by the American Health Information Management Association (AHIMA), or
• Coding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), or
• Health Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), or
• Health Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), or
• Professional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), or
• Health Data Analyst (CHDA) certification issued by the American Health Information Management Association (AHIMA).

Education Required:

• Bachelor's Degree (or equivalent knowledge) in Health Information Management or related field.

Experience Required:

• Typically requires 5 years of experience in coding, health information management and/or compliance for a large complex health care system. Includes 1 year of supervisory experience in health information, clinical, operational or coding function.

Knowledge, Skills & Abilities Required:

• Excellent understanding of medical terminology, anatomy, and physiology.
• Demonstrated skills in financial and statistical analysis, and project management.
• Demonstrated knowledge of third party reimbursement programs, state and federal regulatory issues and ICD, CPT, and/or HCPCS coding.
• Demonstrated proficiency in Microsoft Office or similar products and in patient accounting and billing systems.
• Ability to work effectively with all levels across multiple departments, as well as strong influencing and negotiation skills.
• Strong oral and written communication and presentation skills.

Physical Requirements and Working Conditions:

• Position may require travel which may result in exposure to road and weather hazards.
• Exposed to normal office environment.
• Operates all equipment necessary to perform the job.
• This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.

Pay Range

Our Commitment to You:

Advocate Health offers a comprehensive suite of Total Rewards: benefits and well-being programs, competitive compensation, generous retirement offerings, programs that invest in your career development and so much more – so you can live fully at and away from work, including:

Compensation

• Base compensation listed within the listed pay range based on factors such as qualifications, skills, relevant experience, and/or training
• Premium pay such as shift, on call, and more based on a teammate's job
• Incentive pay for select positions
• Opportunity for annual increases based on performance

Benefits and more

• Paid Time Off programs
• Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
• Flexible Spending Accounts for eligible health care and dependent care expenses
• Family benefits such as adoption assistance and paid parental leave
• Defined contribution retirement plans with employer match and other financial wellness programs
• Educational Assistance Program