Professional Coding Optimization Manager

Major Responsibilities:

• Responsible for managing Mid-Revenue Cycle optimization, data, access, and equipment-related projects and deploying efficient solutions. Manages project timelines and develops plans to ensure projects are completed successfully within deadlines; facilitates project resource allocation and communicates status updates with impacted stakeholders.

 

• Provides consultation on the development of KPIs and ensures accountability for improvement in Mid-Revenue Cycle processes. Maintains metrics for success with key operational leaders and makes data-driven recommendations that promote performance improvement and operational excellence.

 

• Develops data tools, definitions, and reports that support Mid-Revenue Cycle Operations. Collaborates with Mid-Revenue Cycle leaders to evaluate performance improvement needs and provide guidance on appropriate and relevant solutions.

 

• Documents the source of truth for Mid-Revenue Cycle KPIs and promotes data transparency, accuracy, relevancy, consistency, and timeliness across all reporting publications.

 

• Identifies, monitors, and assesses Mid-Revenue Cycle system processes and requirements for assigned applications to ensure effectiveness, consistency, and standardization. Performs workflow analysis and maps Mid-Revenue Cycle critical business processes using industry standards and best practices.

 

• Responsible for all EHR and EHR-interfaced operational functions, such as system logic maintenance, coding, and documentation management workflow designs, and EHR upgrades. Manages the system logic and work queue maintenance programs to regularly review for accuracy, appropriateness, and relevancy.

 

• Participate in service request coordination program for communicating with IT on behalf of Mid-Revenue Cycle Operations. Partners with IT and third-party vendors to ensure all software and interfaces are current, functional, and to reduce potential delays.

 

• Manages Mid-Revenue Cycle teammate equipment, system access, and remote work processes in alignment with organizational policy.
• Collaborates with Revenue Cycle leaders, IT, Compliance, and Clinical Informatics to ensure that Mid-Revenue Cycle practices promote patient safety and support compliant reimbursement practices. Strengthens connections and builds relationships with key operational leaders and stakeholders.

 

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:

5 years of experience in coding, health information management, or revenue cycle technology for a large complex health care system.

Includes 2 years of supervisory or lead experience in coding, health information management, and/or healthcare technology/ project management

Knowledge, Skills & Abilities Required:

• Demonstrated knowledge of facility coding, professional coding, and HIM operational guidelines and workflows.
• Advanced skills in financial and statistical analysis necessary to examine revenue cycle/reimbursement activities and detect/resolve any related issues.
• Extensive knowledge of third-party reimbursement programs, state and federal regulatory issues, national and local coverage decisions, research-related restrictions, and ICD-10, CPT/HCPCS coding classification systems
• Proficient in Mid-Revenue Cycle Epic Modules and other Mid-Revenue Cycle systems
• Knowledge of database structure and reporting. Proficiency in organizing and analyzing data to identify relevant patterns and notable trends.
• Expert in Microsoft 365 products, apps, and services, including Microsoft Teams, SharePoint, Word, Excel, PowerPoint, and Access
• Skilled in prioritizing needs based on business requirements while effectively managing resources and developing effective processes that positively impact the organization.
• Ability to deal and work effectively with multiple departments and in matrix organizational structures.
• Strong presentation and interpersonal skills. Ability to effectively communicate with all levels of teammates, leaders, and clinicians. Proven leadership ability to guide individuals and groups toward desired outcomes.
• Ability to identify and solve problems creatively and to work within deadlines with a high attention to detail.

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.