The CHRISTUS Health Coding Manager is considered a Physician-Based (PB) system support position that provides leadership, support, and direction, for the Director of PB Coding and the coding staff. Coding Managers work collaboratively with system Revenue Cycle, the facility Health Information and Records Services departments, Patient Access Teams, Patient Financial Services, Shared Services, Case Management, Physicians, hospital leadership and management. The Coding Manager is responsible for supporting compliance with CHRISTUS standards and directives, the American Academy of Professional Coders (AAPC), the American Health Information Management (AHIMA), American Medical Association (AMA), and Current Procedural Terminology (CPT) coding rules and guidelines, and other regulatory requirements including Centers for Medicare and Medicaid Services (CMS), Office of Inspector General (OIG) the Joint Commission, and HIPAA standards related to clinic operations. As a Manager, this position ensures that Coding operations are standardized, meet regulatory requirements, and support optimal department performance to support Trinity Clinic operations and revenue cycle initiatives. This position performs timely monitoring and analysis of clinic coding operations to ensure performance objectives are met to support quantity and quality. This position is expected to maintain effective professional relationships as appropriate to instruct, share ideas, and implement actions related to coding functions and improvements. This position monitors and reports KPIs as determined by the Director of PB Coding. The position has direct oversight and accountability for the management of WQs, workload balance, staff development and mentoring, and quality assurance. The Manager has overall responsibility for all staff within the assigned unit and directly supervises the department leads and staff within that unit. The Manager is responsible for ensuring that each team member within the assigned unit is effectively, efficiently, and accurately conducting all aspects of tasks assigned. The Manager provides leadership and direction so that productivity and quality expectations are consistently measured and achieved, backlogs are avoided and promotes and supports a culture of continuous learning throughout the department.
MAJOR RESPONSIBILITIES
Ensure records are coded accurately in regards to CPT, HCPCS, ICD-10-CM Guidelines, Compliance Department policy, and other corporate requirements.
Selects, trains, coaches, motivates, conducts performance evaluations, and directs the workflow for staff assigned to coding function.
Develops goals and performance expectations for staff in targeted areas, such as unbilled accounts receivable, quality and timeliness of clinical coding assignments, data integrity and reimbursement with third party payers.
Provides for the education, development and shared leadership of staff.
Assists in setting and maintaining budgetary department goals for the coding area. Monitors overtime and unbilled to help achieve budget goals.
Participate in organization performance improvements by creating and monitoring the coding scorecard which includes: coding productivity; coding accuracy; WQ backlog, etc.
Monitors goals, productivity and quality standards in conjunction with industry trends and CTC needs.
Participates in developing standard coding policies/procedures/guidelines to ensure compliance with federal, state and local regulatory guidelines to minimize risk for the organization.
Supports coding infrastructure to ensure regulatory compliance in all aspects of coding and abstracting of clinical data to support patient care processes.
Set expectations and allocate work utilizing KPIs to drive productivity and efficiency.
Train, instruct, and provide technical support to medical providers and coding/billing specialists as appropriate regarding coding compliance documentation, regulatory provisions, and third-party payer requirements.
Research root causes and initiate claims resolution in the billing system with knowledge of the upstream and downstream impact of work.
Leverage functionality of Epic to increase clean claim rate, reduce denial rates and increase cash collections, through implementation of claim rules and edits.
Directly communicate with physicians and practice managers on areas of opportunity.
Monitor WQs to maintain grasp on coding backlogs, and proactively shift coders to areas needing additional support.
Counsel employees in performance improvement, conflict resolution, disciplinary action, and coordination of employee schedules for adequate coverage.
Works with departmental appeals staff to identify trends and develop solutions.
Works in conjunction with Compliance to ensure that educational programs are appropriately developed and delivered.
Establishes and maintains a working relationship with physician and other clinical staff with respect to compliance and performance related to coding and regulatory standards.
Assists with evaluation of new clinics and services by researching appropriate coding/billing and payer coverage policies as well as staffing needs.
Holds regularly scheduled staff meetings and makes minutes available to staff and Director.
Maintains effective communication with physician offices to ensure smooth and efficient department operations, advising director as necessary to expedite resolution of any problems
Assumes responsibility for personal and professional development to ensure current knowledge in the profession/position.
Identifies personal and professional areas for improvement and actively seeks out ways to meet personal development needs.
Supervise external vendors who perform the majority of coding to ensure accuracy and compliance.
Ensure coding staff maintains a high quality and productivity standard, per CHRISTUS Health benchmark.
Collaborate with Compliance for physician education regarding coding and documentation requirements.
Acts as a resource for the coding staff as well as serves as a liaison in the organization to address coding related issues and questions.
Disseminates changes in coding rules such as correct coding initiative (NCCI), AMA, CPT Assistant and Coding Clinic.
Monitor changes in laws, regulations, and policies that impact clinical documentation, reimbursement and coding to assure compliance.
Demonstrate an ability to utilize coding/abstracting systems.
Coach coding staff on coding expectations and meeting goals related to both quality and productivity.
Promote morale by effectively communicating goals, standards and needs of the department and organization.
Foster an environment of teamwork and service excellence within the department.
Provide leadership for process improvement and redesign to improve customer satisfaction, reduce costs, and/or meet departmental and institutional goals and objectives.
Work and communicate with all departments, coding professionals, and medical staff to improve documentation in the medical record.
Facilitate cross training opportunities for coders.
Interview, assess and hire new coding associates.
Assist Director in managing and monitoring departmental budget.
Ensure compliance with the OIG, CMS, commercial payer policies, and plays a key role in denials management involving coding related issues.
Perform other duties as assigned.
Requirements:
Bachelor degree, medical record science or medical record administration preferred, or equivalent physician practice leadership experience required.
Subject matter expert in Evaluation and Management, CPT coding guidelines and required documentation. Strong knowledge in ICD-10 CM and HCC coding.
Extensive knowledge of NCDs / LCDs and how to successfully navigate updates to decrease impact to claim processes.
Strong working knowledge of payer denials and policies.
Strong knowledge of payer and clearinghouse claim edits and rules.
Strong presentation skills, with ability to effectively communicate to Executive and Physician leadership teams on KPIs and strategic priorities.
Excellent relationship building skills and aptitude for working collaboratively with cross functional groups.
Able to independently manage multiple tasks and deadlines, with minimal oversight.
Able to clearly document processes and facilitate process to external users.
Demonstrated attention to detail required.
Critical thinker with ability to problem solve, perform root-cause analysis and implement action plans.
Must possess a strong working knowledge in internal integrity requirements and procedures.
Knowledge of governmental, federal, state and local regulations related to billing rules and compliance.
Knowledge of healthcare industry financial statistical indicators.
Must possess strong analytical skills.
Excellent oral and written communication skills required.
Must have strong knowledge of common office software applications including Power Point, Excel, Word, etc.
Minimum of five (5) years' experience in a physician-based coding department of a large group or a mid-large healthcare system, including two (2) years in either a Coding Lead or Coding Manager capacity
Experience with a centralized staffing model preferred
Experience with remote work force operations required Licenses, Registrations, or Certifications (one of the following is required):
CHRISTUS HEALTH is an international Catholic, faith-based, not-for-profit health system comprised of almost more than 600 services and facilities, including more than 60 hospitals and long-term care facilities, 350 clinics and outpatient centers, and dozens of other health ministries and ventures. CHRISTUS operates in 6 U.S. states, Colombia, Chile and 6 states in Mexico. To support our health care ministry, CHRISTUS Health employs approximately 45,000 Associates and has more than 15,000 physicians on medical staffs who provide care and support for patients. CHRISTUS Health is listed among the top ten largest Catholic health systems in the United States.
