Manager, Coding Validation and Quality Assurance - remote

Manager, Coding Validation and Quality Assurance

Location: United States- Remote

Full time

Position:Manager, Coding Validation and Quality Assurance

Department: Clinical Documentation

Schedule: Full Time / Remote

POSITION SUMMARY:

Responsible for the professional development of the coding staff and for providing a hospital-wide educational program to assist coders in continued coding and documentation education. Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders. Provides in-service training and feedback to coding staff regularly, including coding changes and updates. Designs and implements programs on coding and clinical documentation audit and education to improve performance and efficiency. Partners with CDCI management to develop appropriate guidelines regarding IP and OP coding. Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines including Coding Clinic. The Manger, Coding Validation and Quality Assurance may help represent the Clinical Documentation Coding Integrity (CDCI) Department at clinical meetings when requested to serve as a resource for coding guidelines and interpretation.

REQUIREMENTS

EDUCATION:

Bachelors degree or equivalent combination of formal education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CCS and AHIMA Certified ICD-10 Trainer credentials required.

Additional RHIA, RHIT, RN, or other coding credential is preferred.

EXPERIENCE:

• Must have at least five years of experience in coding;experience must include education/mentoring/training. Minimum of five years acute care hospital experience coding with ICD-9/10-CM/PCS and CPT-4, academic medical setting or trauma center preferred. Minimum of three years management experience required;five years preferred.
• Prior experience working claim edits and denials.

  KNOWLEDGE AND SKILLS:

  • Command of the ICD-9/10-CM and CPT4/HCPCS coding conventions, E&M coding, diagnosis-related groupings (DRG) and ambulatory patient groupings (APG) methodology. Work also requires concepts of human anatomy, physiology and pathology.
  • Excellent skill in providing hands-on education to CDCI staff based on audit finding and need.
  • Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required.
  • Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
  • Ability to work with accuracy and attention to detail.
  • Ability to solve problems appropriately using job knowledge and current policies/procedures.
  • Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.
  • Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
  • Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.
  • Work requires in-depth knowledge of medical terminology, ICD-10-CM/PCS and CPT-4 Coding conventions and knowledge of the various DRG systems (CMS DRGs, AP-DRG, and APR-DRGs). Work also requires basic concepts of human anatomy, physiology and pathology.
  • Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.
  • Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.
  • Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.
  • Ability to solve problems appropriately using job knowledge and current policies/procedures.
  • Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.
  • Must possess extensive knowledge of payer claim edits and payer denials. Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding), Ambulatory Patient Classifications (APC), Ambulatory patient Groupings (APG) methodologies, and Fiscal Intermediary Local Coverage Determinations, CMS National Coverage Determinations and various other applicable coding regulations and law.