|Employer:||Shriners Hospitals for Children
|Required Experience:||3 to 4 years
The Physician Coding Manager is responsible for managing the day-to-day operations of physician coding functions and Clinical Documentation Improvement that support revenue cycle professional billing. Responsibilities for the Physician Coding Manager position include managing staff and workflow processes for physician professional E / M coding, procedural coding and physician clinical documentation improvement activities. The position will ensure that work distribution and workflow processes are operating efficiently to manage volumes in support of timely third party billing. Additionally, this position is responsible for maintaining a standardization of coding ethics in compliance with regulatory guidelines.
The Physician Coding Manager will maintain, oversee and report Shriners Hospitals for Children (SHC) physician coding staff member productivity, as well as reporting whether staff meeting established accuracy based on CPT, HCPCS, and ICD10 coding guidelines.
The Physician Coding Manager is responsible for interviewing candidates, hiring recommendations, coaching, and mentoring coding staff, to include counseling / training and annual performance reviews; completing monthly staff productivity reporting, overseeing staff quality audits.
The Physician Coding Manager will report to the Pro-Fee Revenue Cycle Director with continuous and direct interactions with other Revenue Cycle Management, IS, and physicians on a daily basis. The person in this position will monitor the Discharge Not Final Billed (DNFB) Report to ensure that unbilled account issues are resolved and billing is expedited.
The Physician Coding Manager monitors quality assurance indicators for all staff reporting to the Coding Clinical Manager to ensure optimal departmental standards are met.
• Assures areas of responsibility are operating at peak performance as measured through the following goals:
• Works closely with the Lead Coder to ensure that coding productivity and quality audits are conducted monthly on the coding team and physicians (for code selection on super bills) per the Coding Audit Policy and Procedures.
• Analyzes audit findings and takes action as appropriate. Strives to lead coders and physicians to accuracy rate of 95% on each encounter type/super bill.
• Manages and prioritizes coding work queues that manage the distribution of assignments to staff to ensuring timely completion.
• Assures all areas of responsibility are adequately staffed to meet coding/billing, documentation, and medical necessity requirements.
• Routinely interacts with coding and patient accounts department to reduce unbilled accounts and resolve issues related to unbilled accounts.
• Communicates with PFS on issues related to Coding holds related to Change Health.
• Maintains weekly productivity and quality statistics on all staff’s performance to ensure that productivity standards are met. Addresses staff that are not meeting standards by providing additional training, education, counseling and/or corrective action. Communicates with staff at least monthly to inform them how they are performing compared to standards for accuracy and productivity.
• Assists in development and implementation of criteria-based job descriptions and performance standards for all direct staff. Prepares and presents employee performance evaluations to staff and Human Resources in a timely manner. Provides counseling to employees as needed and ongoing training, coaching, and mentoring to coding staff to correct deficiencies in quantity/quality of staff functions.
• Maintains professional skills and refines expertise through appropriate education/developmental activities
• Participates in the planning and design of appropriate system applications for use in professional Coding, Evaluates these systems and initiates appropriate changes or enhancements to meet changing guidelines and mandates imposed by fiscal intermediaries and internal processes as needed.
• Participates in the development of policies and procedures for areas of responsibility. Communicates/enforces department policies and procedures to staff
• Participates in the development of efficient workflow patterns. Manages work in progress; provides guidance and assistance to staff in the completion of difficult duties/responsibilities and resolves coding issues as they arise.
• Participates in the selection/hiring of new employees and coordinates orientation and training for new employees in coding.
• Reviews employee timesheets and validates with timecards in the KRONOS system biweekly.
• Conducts monthly coding staff meetings that encompass both process discussions and educational topics. Develops agendas and maintains minutes/notes of meeting discussions along with attendance records.
• Participates in the analysis of operational problems and special coding projects as assigned. Performs in accordance with system-wide competencies/behaviors.
• Other duties as assigned
THE QUALIFIED CANDIDATE WILL HAVE EXPERIENCE IN THE FOLLOWING AREAS:
• 3 or more years of prior coding experience required
• 3 or more years of supervisory/management experience required
MINIMUM EDUCATION REQUIRED/PREFERRED:
• High School Degree or GED required
• Current CCSP, CCS, RHIA or RHIT certification preferred
KNOWLEDGE AND SKILLS REQUIRED/PREFERRED:
• Capable of working independently and as part of a team.
• Strong knowledge of anatomy, physiology, pharmacology and medical terminology is necessary -good understanding of the principles of ICD-10 and CPT-4 coding classification systems require.
• Prior systems experience with automated encoding / billing systems.
• Excellent communication skills-both verbal and written.
• Proficient with computers; specifically, proficient with Microsoft Office products.
• Ability to elicit and practice cooperation and demonstrate positive morale and team effort is essential.
• Knowledge of Clinical Documentation Improvement activities.
• Knowledge of Medical Necessity criteria for Utilization Management. Leadership Competencies:
• Ability to manage employees in an effective manner to meet departmental objectives is required.
• Organized, detail oriented, able to handle multiple projects simultaneously.
• Ability to analyze date, and possess good problem solving and decision making skills.
• Understand the needs, drivers, and constraints for common ground among a wide range of staff.
• Ability to create team spirit and unite resources from multiple disciplines.
• Ability to provide advice, influence and manage competing priorities and cycles of a heavy workload, in a rapidly changing environment.