Take Care Health Systems, the leading provider of integrated workplace health and productivity management solutions, is seeking a Coding Manager to join our Conshohocken, PA corporate office. This position is a vital member of the Operations Team.
As part of Walgreens Health and Wellness division, Take Care Health Systems includes Take Care Consumer Solutions ( www.takecarehealth.com ), managers of convenient care clinics located at select Walgreens drugstores nationwide, and Take Care Employer Solutions ( www.takecareemployersolutions.com ), managers of worksite-based health and wellness services. The company combines best practices in healthcare and the expertise and personal care of our trusted community of providers to deliver access to high-quality, affordable and convenient healthcare to all individuals. We operate on-site employee health centers, pharmacies and fitness centers for many of the country’s largest corporations and federal agencies.
Position Summary: The Coding Compliance Manager manages small to medium sized projects under limited direction.The Coding Compliance Manager has the responsibility for developing, implementing and maintaining a data quality compliance plan for coding and reimbursement. The Clinical Compliance Manager designs systems and processes to facilitate accurate coding programs for the Take Care Health System clinical team members. This position provides direction and support to ensure correct coding practices that meet government and insurance carrier regulations while maintaining coding policies and training programs that support optimal revenue capture.
Essential Job Functions: Ensure medical coding is complete and without discrepancies prior to billing to ensure accuracy and consistency. Assists in development of coding SOPs, policies and procedures. Leads in maintenance activities for coding databases, including version upgrades, and enhancement of coding algorithm. Resolves error reports associated with the coding and billing processes, identifies and reports error patterns and when necessary assist in the design and implementation of work flow changes to reduce coding and billing errors. Provides and/or oversee quality control review of coding and guidance for in-house or outsourced coding performed by vendors, including coding change requests if necessary. Provides feedback/guidance to providers, Market Managers & Market Educators to assist in the resolution of coding issues. Serves as department liaison at team meetings and interacts with other functional areas to ensure coded data is captured appropriately, approved and delivered within established timelines. Coordinates reviews by the Coding auditors prior to critical timelines and facilitate the generation of queries by the market leadership team. Provides consultative support and assists in coding and HCC training activities as identified or requested Identifies trends/opportunities for improvement in clinical documentation and communicates through the appropriate channels for resolution. Builds consensus among departments and organizational levels to ensure that coding and billing performance standards are approved, understood and achieved Monitors and analyzes coding performance and addresses deficiencies; ensures process improvement and training to resolve continuing deficiencies Participates in decisions related to new software intended to improve clinical documentation, coding accuracy and revenue cycle management, and supervises and manages implementation Manages coding accuracy to accelerate revenue, reduce accounts receivable, reduce claims rejections and errors, provide prompt and professional service for internal and external customers, and improve productivity and profitability Analyzes data requirements of coding, billing, finance staff and senior management, and creates and produces a range of reports to address these needs, including coding accuracy reports, error reports, revenue forecasts, ad hoc reports Facilitates communication among providers, billing, finance and clinical leadership to streamline revenue cycle and to identify and eliminate impediments to productivity and revenue goals Monitors and responds to changes in coding requirements, and keeps appropriate personnel informed. Ensures compliance with regulations, requirements and standards for coding. Manages day to day relationship with third party audit vendor.
Required Qualifications: Bachelor’s degree in healthcare, business, health information management or equivalent combination of education and experience in related field. Certified Professional Coder designation is required from a nationally recognized organization - RHIT, RHIA, CCS, CSSP, CCA . At least 5- years of experience in indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members. At least 5-7 years’ experience in coding, reimbursement analysis, insurance issue resolution and medical record auditing. At least 5 years of experience planning, developing, and managing departmental expense and capital budgets. At least 3-5 years of experience in indirect management of team members, including assisting in the development, training and assignment of work/projects to other team members. Healthcare experience (Healthcare Recovery Auditing, Knowledge of Medical Claim Adjudication, Medical Coding and Billing, and Coordination of Benefits rules). Must have working knowledge of coding complex ambulatory care records. Must have excellent working and current knowledge of Medicaid's Ambulatory Patient Grouping (eAPG) and Medicare's APC reimbursement system. Must have excellent working current knowledge of NCQA HEDIS and STAR measures and ability to assure accurate documentation that leads to appropriate RAFS files for Health Plan partners and CMS. Abides by the standards of Ethical Coding as set forth by the American Health information Management Association (AHIMA) and adheres to all official coding guidelines. Advanced knowledge in the use of specialized references such as the ICD-9-CM and CPT-4 books, medical dictionaries and texts, and medical journals. AHIMA ICD-10-CM/PCS and Medicare HCC Coding experience a plus Excellent verbal and written communication skills Project management and plan development experience Excellent skills in Microsoft Office products, Word, Excel, Power Point and Outlook a must; technologically savvy Ability to handle confidential information with integrity Strong organizational skills with an ability to handle multiple competing priorities. Professional, friendly, a good listener. Ability to work independently in a fast-paced environment Adaptive and flexible to new ideas and change Willing to travel up to/at least 25% of the time for business purposes within state and out of state.
Preferred Qualifications: Master’s degree / MBA preferred . Clinical /Nursing experience a plus Previous experience in physician practice operations preferred
Take Care Health Systems is proud to be an equal opportunity employer
of nice people! M/F/D/V
At Take Care Health Systems we offer a more personalized, human approach to healthcare.
Our Take Care Clinics, conveniently located in...