Manager Physician Coding AR – Hospital & Surgical Specialties (SE Region)

Major Responsibilities:

• Manages the Epic coding functions for all types of charges/codes to ensure that claims are submitted to payers in compliance with coding regulations and organizational guidelines.
• Performs human resources responsibilities for staff which includes coaching on performance, completes performance reviews and overall staff morale. Recommends hiring, compensation changes, promotions, corrective action decisions, and terminations. Responsible for understanding and adhering to the organizations Code of Ethical Conduct and for ensuring that personal actions, and the actions of employees supervised, comply with the policies, regulations and laws applicable to Advocate Aurora's business.
• Oversees the development, documentation, implementation, maintenance and continuous process improvement efforts of production coding for coding staff.
• Identifies trends and implements resolution to charge capture, coding and billing issues and rejections.
• Develops, updates and implements department guidelines and procedures. Educates team members, clinic/hospital leadership and clinicians on coding related guidelines, procedures and practices.
• Communicates and reinforces changes in CPT, ICD, HCPCS and other requirements and coordinates necessary modifications and updates to appropriate coding staff.
• Ensures that documentation, coding procedures and requirements are clearly communicated and reinforced to coding staff, physicians, patient care staff and revenue cycle team members as appropriate.
• Works directly with Coding leadership to research and resolve issues. Collaborates with other leaders in revenue cycle services and clinic/hospital administration, to implement and monitor coding, billing, documentation and charge capture processes.
• Creates highly functioning, self-directed work teams.
• Maintains up-to-date knowledge of Medicare, Medicaid and other regulatory requirements pertaining to nationally accepted coding policies and standards. Develops expertise in coding for assigned responsibilities.
• Manages the timely, accurate review and validation of charges/codes assigned for billing. At times, it may also include customer concerns that question coding. Ensures that coding practices and quality are consistent with coding and other regulatory requirements.
• Ensures that coding practices are standardized systemwide and consistent with regulatory requirements. Documents all coding procedures and guidelines in writing and ensures all coding team members adhere to them. Identifies opportunities for process and quality improvement based upon analysis and review of current practices.
• Abides by the Standards of Ethical Coding as set forth by the American Health Information Management Association and adheres to official coding guidelines. Practices ethical judgment in assigning and sequencing codes for proper insurance reimbursement.

Licensure, Registration, and/or Certification Required:

• Coding Certification issued by one of the following certifying bodies: American Academy of  Coders (AAPC), or American Health Information Management Association (AHIMA)

Education Required:

• Bachelors degree (or equivalent knowledge) in Health Information Management or related field.

Experience Required:

• 7 years of experience in  coding that includes experiences in advanced level of ICD, CPT and HCPCS coding in a large, complex clinic or hospital setting at a lead or senior level. Requires 1 year of progressive leadership experience in a high-volume health care setting.

Knowledge, Skills & Abilities Required:

• High leadership skills and abilities including team building, conflict resolution, project management and effective decision making.
• Advanced knowledge of ICD, CPT and HCPCS coding guidelines. Advanced knowledge of medical terminology, anatomy and physiology.
• Proficient knowledge of Medicare, Medicaid and commercial payer coding guidelines.
• Advanced computer skills including the use of Microsoft office products, especially Excel, electronic mail, including experience with electronic coding systems or applications.
• Excellent communication (oral and written), presentation and interpersonal 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.
• Ability to work independently and exercise independent judgment and decision making.
• Ability to meet deadlines while working in a fast-paced environment.
• Ability to take initiative and work collaboratively with others.

Physical Requirements and Working Conditions:

• Exposed to a normal office environment.
• Must be able to sit for extended periods of time.
• Must be able to continuously concentrate.
• Position may be required to travel to other sites; therefore, may be exposed to road and weather 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.