To be fully engaged in providing Quality/No Harm, Customer Experience, and Stewardship by assuring timely, complete, and accurate data collection for appropriate reimbursement and clinical quality analysis. The Health First Medical Group (HFMG) Manager Coding is responsible for planning, coordinating, organizing, implementing, overseeing, and managing all professional coding activities which include but are not limited to; education activities for coders, clinical documentation specialists, physicians and practice staff, compliance and auditing, performance improvement activities, professional fee reimbursement related concerns, staffing and training, Information Technology as it relates to the coding department, denial management, and supporting all locations of Health First Medical Group representing the Revenue Cycle Department in all coding concerns.
• Provides leadership through effective communication, expressing ideas in a clear, professional, positive, creative, and succinct manner.
• Efficiently utilizes personnel resources to plan, organize and coordinate the daily activities of the Coding functions to ensure goals and objectives are met.
• Identify problems associated with assigned team members in a timely manner, lead team to skillfully investigate and analyze information, develop alternative solutions to problems and resolve issues in the early stages. Promote teamwork when the resolution of problems involves interdisciplinary teams.
• Provide performance coaching to assigned associates by defining responsibilities and expectations, setting individual goals and objectives, giving performance feedback, recognizing contributions and encouraging training and development.
• Staff team appropriately by utilizing recruitment sources, exhibiting sound interviewing skills, presenting a positive and realistic view of Health First, analyzing and forecasting staffing needs and making quality hiring decisions.
• Match responsibilities to team members appropriately, give authority to work independently, set expectations and monitor delegated activities and provide recognition for results.
• Exhibit clear, sound and accurate judgment in making decisions. Display willingness to make decisions in a timely manner, include appropriate people in decision making process and be able to explain reasoning for supported decisions of the team.
• Completes associate evaluations on a timely manner for all associates in the Business Office, meeting expected timelines set by Human Resources. Yearly evaluations due within 30 days of associate's anniversary date, and 90-day evaluations done on or before associate completes 90 days of employment.
• Plan, organize, and oversee coding educational activities for coding staff, clinical documentation staff, clinical staff, and physicians. (Including Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), Hierarchical Condition Categories (HCC) and International Classification of Diseases, 10th revision (ICD-10) education).
• Participates in the development of corporate, organizational-wide, and department-specific policies and procedures to ensuring compliance with regulatory guidelines in all activities.
• Complies with patient confidentiality guidelines, including HIPAA requirements, code of conduct, and standards of behavior.
• Create and maintain coding compliance plan as guided by the Office of Inspector General, AHIMA best practices and other coding governing bodies.
• Serve as a resource for annual CPT/HCPCS code updates and charge master validation.
• Provide support and lead activities related to proper CPT usage for services rendered within the clinic locations (including electronic fee ticket and unclassified code updates).
• Coordinates with various departmental staff who are responsible for charge capture areas of responsibility and implement changes as necessary.
• Have a broad knowledge of insurance regulations and Medicare and Medicaid guidelines as well as knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, billing
• Looks for ways to improve and promote quality in the workplace and with the team through technology and process solutions. Ensure that quality improvement processes are in place and monitor quality indicators. Display commitment to excellence, provide and apply feedback to improve performance and demonstrate accuracy and thoroughness.
• Be innovative where necessary by displaying original thinking and creativity. Promote suggestions for improving team activities, encourage team to meet challenges with resourcefulness and develop innovative approaches and ideas when appropriate.
• Participates in Health First approved educational programs and activities related to the HFMG mission to keep abreast of current trends, best practices, and new developments in healthcare information technology as they relate to specific job responsibilities.
• Assist in negotiating outsourced coding service contracts by working with the Director Professional Fee Revenue Cycle and the Health First legal department.
• Represent the HFMG Coding Department in all computer technology and health information applications needed for departmental efficiency, in addition to data collection, access, control, transmission and transparency.
• Develop standardized workflow processes to ensure standardized coding/charge capture workflow, including the use of Computer-Assisted Coding tools to maximize efficiencies. This includes understanding the use of natural language processing and structured data input in order to understand how these technologies link to codes to ensure accurate charge capture.
• Assist in the development of HCC coding activities to support the Population Health initiatives for Health First.
• Manage the activities of outsourced coding services by reconciling billing statements and monitoring ongoing regulatory compliance.
• Have a broad knowledge of insurance regulations and Medicare and Medicaid guidelines as well as knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation and coding
• Actively participates in testing of new equipment and systems.
• Ability to present educational information to various levels of the organization in the area of Coding and Clinical Documentation, including Senior Leadership, providers, practice managers and associates.
• Coordinates with various departmental staff who are responsible for coding in their departments to implement changes due to regulatory requirements, operating efficiency needs as well as develop programs to educate staff on all necessary changes.
• Effectively communicate departmental and project status and operational issues to Director, team members and HFMG associates through verbal and written communication. Keep Director and others adequately informed through status reports and other appropriate forms of communication. Ensures appropriate and timely communication to users of information systems for items such as change notifications, upgrades, scheduled and unscheduled downtimes through defined communication.
• Manage competing demands for assigned team. Adapt to changes in the HF environment as necessary. Accept criticism and feedback in a constructive nature and change approach or method to best-fit situations. Clearly prioritize and plan work activities, use time and resources efficiently, plan for additional resources as necessary, integrate changes to the team smoothly and set goals and objectives for the team.
• On an annual basis and in conjunction with Director, determine projects, milestones, and goals for HFMG Coding department. Provide support and guidance for project management of HFMG initiatives. This includes developing project plans, coordinating projects, communicating changes in projects, completing projects on time and on budget and managing project team activities.
• Provide outstanding customer service to the Health First organization by displaying courtesy and sensitivity, managing difficult or emotional customer situations, meeting commitments, responding promptly to customer needs and soliciting customer feedback to improve service.
• Be accountable for the activities of the Coding team including responding to customer requests for service, following established standards, keeping team commitments and meeting attendance and punctuality guidelines. Provide escalation point for internal customers when needed.