Accept the Challenge…Make a Difference
University of Florida Jacksonville Healthcare, Inc. has supported the University of Florida's physician practice in Jacksonville and other northern Florida and southern Georgia communities since 1971. UFJHI provides a wide range of business services to one of the largest mixed specialty practices in the southeastern United States consisting of over 300 physicians working in 30 clinics. UFJHI is an exciting and challenging place to work. We really care about the communities and patients that we serve. Our employees work alongside nationally and internationally renowned physicians who are engaged in teaching and research as well as providing healthcare services. Primarily located in Jacksonville, Florida, UFJHI also offers a great north Florida lifestyle with countless recreational activities, museums, orchestras along with professional and amateur sports.
Scope of the Job
Manages the CDQ–Education Department. Serves as a subject matter expert for the organization in coding-related matters. Formulates department policies that determine work responsibilities and department processes. Coordinates and balances the educational efforts and activities of the department to ensure maximum efficiency in meeting the organization’s educational needs as they relate to coding. Oversees the activities of the Education Specialists.
Writes, edits, and approves all content associated with the aforementioned educational/training programs, including text, handouts, and tests, and designs and approves classroom exercises. Determines training objectives and is responsible for initial plan and design of class material, as well as enhancing existing courses. Ensures that training is updated at a minimum of once a year to account for industry changes. Ensures that coding and billing newsletters are published as issues and trends are identified. Has in-depth knowledge of commonly-used concepts, practices, and procedures within medical coding and billing. Relies on experience and judgment to plan and accomplish goals. Works under general supervision; reports to a director. A certain degree of creativity and latitude is required.
The essential functions are the primary dimensions for performance review.
Oversee and coordinate the activities of the Education Specialists, including monitoring of workflow and quality of output and educational activities.
Review industry correspondence and literature, summarize pertinent coding and reimbursement information, and distribute to appropriate providers, clinic staff, and UFJP personnel.
Interact with follow-up and collection personnel to obtain current and revised carrier reimbursement information, and distribute pertinent findings to appropriate personnel.
Work with the Business Groups, Medical Departments, GME Office, Ambulatory Services, and the Office of Physician Billing Compliance to ensure the organization’s full compliance with providers’ annual Mandatory Provider Education program educational requirements.
Assist business group and satellite staff with coding and reimbursement policy questions.
Research and resolve coding and reimbursement policy issue questions.
Prepare, conduct and/or assign diagnosis/procedure coding training for new providers. Training topics will include Evaluation & Management coding/documentation, Teaching Physician documentation guidelines, Billing Compliance, Non-physician practitioner billing, and specialty-specific coding guidelines.
Prepare and conduct and/or assign annual diagnosis/procedure coding, chart documentation, specialty-specific coding, and Evaluation & Management documentation training for residents.
Prepare, conduct and/or assign annual and periodic refresher training to all providers on the topics of Evaluation & Management coding/documentation, Teaching Physicians documentation guidelines and Billing Compliance.
Monitor the effectiveness of the above education that is delivered as part of the Mandatory Provider Education program and assist the Manager and Director of Physician Billing Compliance in re-directing the focus of the educational content as needed.
Coordinate follow-up education and training given to providers with the Office of Physician Billing Compliance.
Prepare, conduct and/or assign CPT-4 and ICD-9 coding/reimbursement training for personnel. Topics to include general healthcare concepts, medical terminology, anatomy, procedural and diagnosis coding, teaching physician documentation guidelines, E&M documentation guidelines, and specialty-specific coding issues.
Prepare and conduct special and/or advanced educational/training sessions as necessitated by changes in carrier coding/reimbursement policies, coding/documentation deficiencies, or problematic reimbursement issues.
Ensure that all educational/training material is prepared and updated on an annual basis.
Determine training objectives of new classroom offerings and future in-services.
Write (and oversee and approve the authoring of) training material, including text, handouts, and tests.
Design (and approve) classroom exercises.
Publish (and review) periodic newsletters with coding and billing information for providers and staff.
Oversee and coordinate the annual review of superbills sent from the Reimbursement Department.
Assist Manager of Reimbursement and Director of Clinical Data Quality with research and analysis for special reimbursement projects.
Other duties as assigned
Must be able to perform under stress when confronted with emergency, critical, or unusual situations. Must be capable of dealing with periodic cyclical workload pressures and levels of responsibility. Required to make independent judgments without supervision. Must be able to make generalizations, evaluations, or decisions based on sensory or judgmental criteria. Must have the adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure. Requires the ability to work with people beyond giving and receiving instructions.
SKILLS, QUALIFICATIONS, AND REQUIRED EXPERIENCE
Excellent oral and written skills.
Excellent presentation skills in a group and individually.
Proficiency with CPT-4 (including HCPCS Level II) procedural coding, and ICD-9 diagnosis coding.
Proficiency with anatomy/physiology and medical terminology.
Proficiency with CMS’ Evaluation and Management Guidelines, CMS’ (and other government payers’) Teaching Physician regulations, and CMS’ (and other government payers’) non-physician practitioner billing rules.
Proficiency in auditing medical records to determine accurate coding.
Ability to manage multiple priorities and deadlines.
Ability to supervise and train direct reports.
Ability to work independently and as part of a team.
Ability to coordinate educational/training efforts with other departments that are also involved in delivering education/training to providers and business staff.
Financial and reimbursement analysis skills.
Proficiency with software applications: Windows, Excel, Word, PowerPoint, HealthStream, Adobe Captivate, and Adobe PageMaker.
Experience with management information systems and medical software.
Ability to gather data, compile information, and prepare reports.
Ability to interact effectively with staff and outside contacts on a variety of levels.
5 or more years experience in physician/professional fee billing/coding, billing compliance review/audit, physician/business staff billing/coding education, or a strongly-related healthcare area.
2 or more years prior supervisory experience.
Medical billing/claims experience including coding, medical terminology, and third party reimbursement.
Education/training experience preferred.
Proficiency with PCs and word processors.
Proficiency in education/training and group presentations.
Education and Certifications
Associate’s Degree required. Bachelor’s degree in Business Administration, Healthcare Administration, Nursing, or Adult Education preferred. A combination of 7 years education and comprehensive experience with physician coding, billing, reimbursement and compliance may be substituted for health care degree.
Certified Professional Coder (CPC) certification through the AAPC or a Certified Coding Specialist–Physician-Based (CCS-P) through AHIMA required.
Advanced Coding certification relevant to E/M coding/auditing, or other relevant advanced coding certifications preferred.