Job Purpose: Lead Certified
Professional Coders (CPCs) to generate the best possible financial outcome for
the practices at the lowest possible compliance risk through primary care
advocacy, research, collaboration, structured communication, and standardized
processes.
Essential Duties and Responsibilities
Operational:
• Ensure compliance to:
o
Coding standards as defined by the AMA
through CPT, ICD, and HCPCS
o
Government and Commercial Payer
Contracts
o
Accountable Care Organization (ACO)
agreements
o
CPT Category II quality reporting
• Hold and attend regular meetings with coders, billing staff, providers, managers,
and other stakeholders to share information and communicate on company issues,
as needed
• Interview, hire, and provide orientation to coding staff
• Reporting including, but not limited to:
o
Monthly status reports
o
Insurance fee schedules
o
Charge lag including claims awaiting
provider completion and claims awaiting coding.
• Support Avance Care’s strategic execution of ACO agreements, as they
relate HCC/RAF, CPT Category II coding, and other coding deliverables.
• Compliance planning as it relates to government and private contracts,
rules, and regulations, including execution of compliance policy and procedure
at the coding level.
Claims Management:
• Execute all facets of the coding aspect of revenue cycle management.
• Ensure scalable but nimble coding structure that supports the
organization’s growth plan
• Supervise and train coding staff, both local and outsourced.
• Manage department workload and growth, including assignment of work and
staffing plans
• Regularly review coding and documentation for accuracy and compliance.
• Supervise all coding employees in order to:
o
Ensure adherence to Avance Care Policies
and Procedures
o
Encourage employee behavior that
represents the company in the best light
o
Ensure standardized processes are
executed efficiently
• Oversee all claims production, including creation, submission, secondary
claims, and charge lag.
Personnel Management
• Resolve conflicts within the department
• Resolve issues outside the billing department, such as providers,
operators, or regulators
• Communicate effectively and politely with all staff members to minimize
and eliminate employee dissatisfaction and conflicts
• Address employee complaints in a timely manner
• Interview, train, counsel, coach, discipline, and terminate employees, as
necessary
• Manage employee scheduling, vacation requests, and continuous shift
coverage
• Conduct staff meetings to share information and communicate on company
issues
• Train new and existing providers, with assistance from coding team
• Review, revise (as necessary), and maintain Operating Procedures and
Training Manuals
• Conduct bi-annual employee performance evaluations
• Notify the Vice President of RCM, Human Resources, and other managers of
all non-routine matters relating to the operations and affairs of the areas for
which the position is responsible, including but not limited to significant
concern, current problems, and potential problems
Expectation
of Employee
•
Understand, follow, and enforce
Avance Care’s Policy and Procedures, as documented in the Policy and Procedure Manual
•
Always maintain company, employee, and
patient confidentiality
•
Maintain an effective relationship
with physicians, employees, co-workers, and management
•
Work at least 40 hours each week
•
Work as a team player
•
Use strong computer skills and
general math skills
•
Use strong attention to detail
•
Uses superior judgment, negotiation,
and decision-making skills
•
Capability to guide the
organization and execute various changes
•
Perform administrative and coding
duties as workload necessitates
•
Use tact in all personal and
patient interactions
•
Demonstrate flexible and efficient time management
and ability to prioritize workload
•
Consistently report to work on time for scheduled
shift, prepared to perform duties of position
•
Accomplish all tasks as assigned or
become necessary
Qualifications
Experience,
Education and Licensure:
•
Batchelor’s Degree required (MHA or
MBA preferred)
•
Minimum 5-7 years office-based coding
management experience
•
CPC Certification required
(additional certifications such as CPME, CRC, CDEO preferred)
•
Multispecialty, hospital,
ambulatory, and/or surgical coding experience preferred
•
Knowledge of CPT, HCPCS, and ICD-10
coding
Knowledge,
Skills, and Abilities:
•
Ability to read and interpret
documents
•
Ability to write reports, business
correspondence, and procedure manuals
•
Ability to effectively present
information in person and virtually
•
Ability to interact and communicate
with a variety of people
•
Ability to anticipate and react
calmly to emergency situations
•
Ability to work with mathematical
concepts such as probability and statistical inference; ability to apply
concepts such as fractions, percentages, ratios, and proportions to practical
solutions
•
Ability to define problems, collect
data, establish facts, and draw valid conclusions
•
Ability to make independent
decisions and delegate responsibility and duties
•
Ability to follow direction
•
Proficient computer skills,
including knowledge of EHR, Microsoft Office Suite, e-mail systems, and
web-based programs
•
Ability to handle multiple tasks
simultaneously
•
Excellent supervisory, managerial skills
•
Strong leadership qualities
•
Knowledge and understanding of how
for-profit medical practices run
•
Working knowledge of accounting,
including ledger, balance sheet, payroll, taxation, etc.