Supervisor Physician Coding A/R – Surgical/Complex Specialties

Major Responsibilities:

• Oversees the collaboration with Customer Service, analyze and resolve professional coding complaints in a timely manner using correct coding and payer guidelines to ensure patient satisfaction.
• Oversees the identification and analysis of coding denials for a specific population of charges and works in collaboration with the Production Coding team. Supervises and coordinates coding rejection data collection activities used for reporting and accountability tracking. Identifies potential trends or knowledge concerns and opportunities for improvement and prevention.
• Monitors the research and documentation of applicable regulatory, coding and billing rules. Develops standardized processes and tools for the coding production team to utilize when dealing with insurance rejections and recommendations to avoid future denials.
• Collaborates with Professional Coding Leadership to develop monthly coding update reports to continually educate and communicate coding related recommendations based on monthly findings. Maintains up-to-date information regarding coding denials and rejections and communicates the changes accordingly.
• Supervises the identification and problem solving of trends and issues. Collaborates with department leadership clinic operations managers, system contracting team to determine preventative measures, follow-up and resolve these issues. Communicates with and acts as a resource for others regarding coding and appeal issues.
• Oversees and provides regular statistical reports to leadership regarding rejection/denial volumes, response timeliness, success rates, identified trends, and recommendations to prevent future coding rejections/denials.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally and locally (i.e., NCD, LCD) accepted coding policies and standards. Develops expertise in coding for assigned specialties. Communicates and reinforces changes in CPT, ICD-10-CM/PCS, HCPCS and other requirements and coordinates necessary modifications and updates appropriately.
• Monitors retrospective chart reviews and claim coding reviews. Responsible for team’s identification of coding errors, oversees and recommends correct coding based on CPT, ICD-10 CM/PCS, HCPCS in accordance with coding and payer guidelines.

Licensure, Registration, and/or Certification Required:

• Coding Associate (CCA) 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
• Specialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC).

Education Required:

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

Experience Required:

• Typically requires 5 years of experience in advanced professional coding, physician billing processes and workflow and reimbursement in a large, complex clinic or hospital setting. Experience at a lead or senior level required.

Knowledge, Skills & Abilities Required:

• Demonstrated leadership skills and abilities including team building, conflict resolution, project management, and effective decision making.
• Exceptional knowledge of ICD, CPT and HCPCS coding guidelines. Advanced of medical terminology, anatomy, and physiology.
• Advanced ability to identify coding discrepancies and provide recommendations for improvement and advanced ability to analyze trends and data and display them in a statistical reporting format.
• Advanced knowledge of care delivery documentation systems and related medical record documents.
• Expert knowledge of Medicare, Medicaid, and commercial payer coding guidelines.
• Advanced computer skills including the use of Microsoft Office, email and exposure or experience with electronic coding systems or applications.
• Advanced interpersonal and communication (oral and written) skills, including the ability to effectively collaborate with multiple departments.
• Excellent organization and prioritization skills; ability to manage multiple priorities in a stressful, fast-paced work environment.
• Excellent analytical skills, with a great attention to detail.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment and to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Ability to drive and/or travel to work related functions/meetings, will be exposed to road, weather and normal travel hazards.
• 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.