|Employer:||CHOC Children's Hospital
|Skills:||Coding,Billing,Compliance,Auditing,Training,Electronic Medical Record,Written Communication skills,
|Required Certifications:||CPC or CCS-P,National Professional Certification in Medical Billing
|Preferred Certifications:||Pediatric Coding Certification,Registered Nurse License
|Required Experience:||5 to 7 years
The Manager, Professional Coding Compliance & Education is responsible for the daily operations of the Medical Foundation professional services coding compliance program, comprised of CHOC Children’s Specialists (CHOC CS) and the Primary Care Network (PCN). The Manager, Professional Coding Compliance & Education is responsible for the development and execution of chart audit work plans for professional services, as well as preparation and delivery of coding and documentation education programs for Medical Foundation providers to ensure quality and consistency of documentation in compliance with applicable CHOC policies, coding guidelines, standards, and state and federal regulations. The Manager, Professional Coding Compliance & Education is integral in the development of policies and procedures associated with coding and billing compliance.
- 5 years of professional experience in coding and billing compliance and/or auditing
- 2 years of experience in educating/training providers
- Strong knowledge of Medicare, Medi-Cal, Private, PPO, and HMO payer coding and billing requirements/guidelines
- Experience leading coding/documentation initiatives involving physicians and other providers
- Experience with electronic medical record (EMR) systems and in-depth knowledge and understanding of system documentation and coding processes
- Working knowledge of coding audit management software
- 7+ years of professional services coding/billing/auditing experience in pediatric environment
- 5+ years of experience in educating and training providers on coding/billing/documentation standards.
- 2+ years managerial experience
- Experience with Cerner EMR.
- Experience as system administrator for coding audit management software
- Advanced data analytics skills
- Master’s degree
- Bachelor’s degree or equivalent education, training, and experience can be accepted in lieu of education
- Excellent verbal and written communication skills.
- Ability to communicate effectively with all levels of staff, leadership, and providers; active listening skills
- Excellent relationship building skills
- Demonstrated project management, organization and facilitation skills.
- High level of personal integrity, and the ability to professionally handle confidential matters and exude the appropriate level of judgment and maturity
- Adept at navigating and managing through ambiguity and complexities
- Risk based approach to establishing work priorities and ability to develop practical recommendations to address areas of concern
- Value-added mindset that seeks to have a positive impact on advancing the CHOC Children’s mission, vision, and strategic initiatives
- Critical thinker with outstanding analytical and problem-solving capabilities
- Ability to effectively manage multiple priorities, maintain high performance standards and execute tasks in a high-pressure environment
- Proficient in provider documentation review and understanding provider workflow
- Self-motivated, detail oriented, ability to work independently, and strong understanding of coding guidelines, CMS, Medi-Cal, & Cal Optima coding, compliance and billing requirements
- Demonstrated history of strong working relationships with providers, team orientation, and ability to positively influence
- National professional certification in medical coding (i.e., CPC or CCS-P)
- Pediatric Coding Certification, Registered Nurse license