Manager Professional Coding Integrity

PURPOSE OF THIS POSITION

The primary purpose of this position is to manage the overall operations of the professional coding integrity team, including the overall performance of the professional coding program to ensure consistency, accuracy, compliance, optimal reimbursement and reduced denials. The Manager will collaborate with providers and clinical department leadership to support the integrity of the documentation to support the charges entered and the codes assigned.

This position reports to the Director of Health Information Services. The Professional Coding Integrity Supervisor, the Professional Coding Auditor and Educator and the Professional Coding Claims Resolution Specialist positions report directly to this position.

Duty 1: Provide management oversight of the professional coding integrity team and related functions with the primary objective to support the optimal performance of the professional coding program, which includes proper ICD-10 /CPT code assignment to ensure compliance with applicable regulatory standards, maintain a high level of quality and consistency, optimize reimbursement, and reduce denials. Effectively communicate and solicit input from team and other impacted areas to promote a collaborative and innovative team environment, translating BVHS’s Mission, Vision and Values into front-line action.

Duty 2: Perform and/or provide oversight to managerial administrative support functions including but not limited to facilitate the recruiting and hiring process, training & education of associates, monitor appropriate staffing levels, payroll, performance evaluations, recognition and reward, disciplinary follow up as appropriate, establish/monitor performance metrics, monitor completion of organization requirements. Assist Director in developing and monitoring department budget and strives to control departmental costs.

Duty 3: Active engagement to support organization cascading goals initiative, including idea boards, associate engagement, service excellence and contribution margin.

Duty 4: Recommend and implement professional coding compliance plan and related policies and procedures to promote compliant and consistent coding practices, inclusive of ICD/CPT code assignments which are reflective and supported by clinical documentation. Monitor and modify plan in anticipation of changing organizational needs (e.g. implement a new service line) and/or in response to revised regulatory requirements (e.g. IPPS and OPPS annual updates, CPT Assistant, Coding Clinic, etc.).

Ensure appropriate dissemination of information and education to ensure coding integrity team and/or any other pertinent individuals or departments remain current on coding compliance plan/policies and procedures.

Duty 5: Provide oversight of the professional coding integrity quality audit program to ensure the overall accuracy of work performed. Oversee and monitor the results of quality audits performed by Professional Coding Auditor and Educator and support the resolution of identified opportunities through the creation and implementation of an action plan. Monitor third party payer audits and assist, as necessary, defending takebacks and in the appeal process related to code assignments and evaluate opportunities to reduce coding denials.

Ensure relevant decisions related to coding practice are documented in policies or procedures to promote ongoing standardization and consistency.

Duty 6: Develop and track key metrics to measure overall performance of team operations. Analyze data to determine opportunities for improvement and implement follow up or action plans to address. Evaluate workflows and processes to address issues that may be causing delays or for opportunities to continue to optimize operational efficiencies. Strive for continuous performance improvement through monitoring industry best practices and evaluating / implementing tools and processes to enhance work performance and outcomes.

Duty 7: Collaborate with Corporate Compliance Department in audits or initiatives related to professional coding and charge processes. This may include involving team in coding reviews in response to an investigation or potential compliance risk, conducting charge-related research, assisting to develop an audit tool or interacting with third party consultants conducting a compliance audit.

Duty 8: Collaborate and maintain open communication with the medical providers and clinical leadership on coding and documentation practices with a primary focus to maintain compliant practices which accurately reflects reporting of coded data and provider metrics. Foster positive relationships with providers and clinical teams to create a spirit of partnership and alignment of organizational goals. Provide feedback and education to providers / clinical team on opportunities identified.

Duty 9: Regularly attend and actively participate in relevant education / conferences, organizational meetings and continuing…