The Manager, Coding will collaborate closely with the Director of Clinical Coding serving as the Subject Matter Expert on coding within the Hospital Bill Review Department. This will include creating and implementing program policies and procedures to ensure best practices. In addition, The Manager, Coding will research and stay abreast of inpatient and outpatient coding updates to ensure the team is capturing all potential saving opportunities. The Manager, Coding will investigate areas of coding opportunities within the current product and be responsible for recommending/documenting new opportunities, conducting training, and tracking performance impacts. This role will also be responsible for interpreting and assessing client payment policy data and assisting with provider disputes.
- Serve as a coding subject matter expert for Hospital Bill Review Department and clients to identify whitespace in current projects related to coding reviews and create strategy to tackle
- Implementation of new coding areas of savings to include: Research, ROI analysis, SOP’s, client support documents, training materials
- Participate in client facing meetings as necessary to assist in presenting coding results with supporting references
- Assist in dispute process and defense of denials as necessary
- Conduct ongoing team education regarding coding and/or billing errors including development of training materials
- Ability to push initiatives from inception to completion
- Must remain current in all national coding guidelines including Official Coding Guidelines, AHA Coding Clinic and AMA CPT Assistant
- Work closely with all Leaders of Hospital Bill Review in departmental functions and special projects
- Evaluate program performance, prepare reports, and make recommendations for program development
- Must have an understanding of health plans and lines of business in addition to their interaction with policies and coding guidelines
- Management of a team may be required
- Work closely with leadership to ensure Zelis culture
- Maintain awareness of and ensure adherence to Zelis standards regarding privacy
Technical Skills / Knowledge:
- Superb understanding of Medicare, Medicaid, and Commercial guidelines.
- Demonstrates solid understanding of audit techniques, identification of revenue opportunities and financial negotiation with providers.
- Proficiency in training techniques aimed at conveying subject matter expertise and scaling staff to maximize savings and revenue.
- Computer proficiency and technical aptitude with the ability to utilize RevenueCyclePro, other audit software and tools, MS Office Suite.
- Requires minimal daily supervision.
- Regularly reviews goals and objectives with supervisor.
- Achieve personal production goals and savings quotas.
- Ability to follow detailed instructions on new assignments.
- Accountable to day to day tasks.
- Must have professional manner and respect the confidentiality of administrative matters and files.
- Ability to manage and prioritize multiple tasks.
- Ability to work under pressure and meet deadlines.
- Makes logical suggestions as to likely causes of problems and independently recommends solutions.
- Excellent organizational skills are required to prioritize responsibilities, thus completing work in a timely fashion.
- Outstanding ability to multiplex tasks as required.
- Excellent project management skills.
- Attention to detail and concern for impact is essential.
- Provides guidance to lower level personnel.
- Regularly attends meetings and leads training sessions.
- Must be proactive to ensure proper follow up and completion of projects.
- Must maintain a professional demeanor in sensitive situations.
- Assists other departments as necessary.
- Must work well with others.
- Effectively communicate with others by giving and receiving feedback.
- Communicates ideas and information clearly.
- Must have excellent written and verbal communication and presentation skills to effectively interface with the entire staff, and external representatives from the business, financial, legal, and scientific communities.
- Travel requirements to (primarily) domestic destinations should not exceed 10%.
- Inpatient Coding certification required (i.e., Certified Coding Specialist (CCS) or Certified Inpatient Coder (CIC)).
- RHIA or RN preferred, but not required.
- 5+ years of relevant experience or equivalent combination of education & work within healthcare system.
- 1+ year experience of management experience.
- Experience with payment integrity preferred
- Demonstrates in depth understanding of medical claims processing in addition to ICD10.
- Demonstrates a proficiency in analyzing hospital claims and medical record documentation.
- Experience and working knowledge of Health Insurance, Medicare guidelines and various healthcare programs.
- Demonstrated track record of success in managing key process improvement initiatives.
- Industry experience implementing complex programs.
- Experience managing internal and external relationships.
- Excellent verbal & written communication skills.
- Walking, standing and sitting.
· Long periods of computer usage.
· Handling – seizing, holding, grasping and fingering of objects, tools and controls.
· Vision – close vision.
- Hearing- ability to receive detailed information through oral and telephonic communication.
- Ability to lift and move approximately thirty (30) pounds on a non-routine basis.
- Ability to sit for extended periods of time.
- A standard work week exists but with the understanding that additional time/effort outside of the usual parameters can/will occur based upon the overall needs of the integration, where deadlines exist and when necessary due to the needs of the integration team.
- A standard business environment exists with moderate noise levels.