Position Summary

Responsible for managing and coordinating the overall coding functions of the Business Office to ensure maximization of cash flow while improving patient, physician and other customer relations.  The Director will ensure that accurate, coded data exists for optimal reimbursement by the organization and coordinate all quality and compliance monitoring of assignments for hospital and professional technical services.

Work Schedule

Monday – Friday, 8-5 or as determined by manager.

Primary Duties

• Serves as a resource and support person for the medical staff and hospital in coding and billing.
• Reviews physician documentation and provides continued education to both medical staff and CDS team when needed.
• Reviews with Denial Team Director trends associated with denials associated with coding and documentation
• Evaluates the impact of innovations and changes in programs, policies, and procedures for the coding unit. Designs and implements systems and methods to improve data accessibility. Identifies, assesses, and resolves problems. Prepares administrative reports.
• Monitors and maintains acceptable accounts receivables associated with un-coded charts.
• Oversees and monitors the coding compliance program. Develops and coordinates educational and training programs regarding elements of the coding compliance program such as appropriate documentation and accurate coding to all appropriate staff including coding staff, physicians, billing staff, and ancillary departments. Ensures the appropriate dissemination and communication of regulatory, policy, and guideline changes.
• Conducts and oversees coding audit efforts and coordinates monitoring of coding accuracy and documentation adequacy. Reports noncompliance issues detected through auditing and monitoring, the nature of corrective action plans, and the results of follow-up audits to the directors of hospital and the compliance officer.
• Conducts trend analyses to identify patterns and variations in coding practices and case-mix-index. Compares coding and reimbursement profile with national and regional norms to identify variations requiring further investigation.
• Reviews claim denials and rejections pertaining to coding and medical necessity issues and, when necessary, implements corrective action plan (such as educational programs) to prevent similar denials and rejections from recurring.
• Interacts with a variety of people who impact the success of coding compliance program, and functions as a facilitator, liaison, and/or motivator.
• Maintains staffing and operational expenses at a minimum.
• Supervises and schedules staff to ensure adequate coverage for departmental operation.
• Performs annual performance evaluations of subordinates timely.
• Always observes confidentiality of all information.
• Responds to questions from physician and non-physician employees about billing and coding.
• Attends CPC meetings as needed.

Knowledge:

• Knowledge of business management and basic accounting principles to direct the business office.
• Knowledge of computer accounting programs, spreadsheets and applications.
• Knowledge of medical terminology, coding and office procedures.
• Knowledge of third-party and insurance company operating procedures, regulations and billing requirements and government reimbursement programs.

Qualifications/Specifications

•        Education: High School diploma or equivalent required. Bachelor’s degree in health information management preferred.

•        Licensure/Certification: Procedural Coder Certification require

•       Experience: Minimum of five years hospital and professional coding experience required.