Manager, Professional Billing Coding Operations - Remote

Boston Medical Center (BMC) is more than a hospital. It´s a network of support and care that touches the lives of hundreds of thousands of people in need each year. It is the largest and busiest provider of trauma and emergency services in New England. Emphasizing community-based care, BMC is committed to providing consistently excellent and accessible health services to all—and is the largest safety-net hospital in New England. The hospital is also the primary teaching affiliate of the nationally ranked Boston University School of Medicine (BUSM) and a founding partner of Boston HealthNet – an integrated health care delivery systems that includes many community health centers. Join BMC today and help us achieve our Vision 2030 which is a long-term goal to make Boston the healthiest urban population in the world.

Position: Manager, Professional Billing Coding Operations

Department: Coding and Education

Schedule: Full Time

POSITION SUMMARY:

Responsible for the operational functions of the Professional Coding Operations team for BUMG.  Plays a strategic role in validating the accuracy of CPT, HCPCS and diagnosis code assignment by coders, physicians and non –physician practitioners. Works closely with key revenue cycle stakeholders to understand reasons for denials, root cause analysis, and feedback to providers. Supervises professional billing coding staff.  Partners with Coding Education Team to identify trends in coding practices and assists with developing feedback and education to providers.  Reviews coding denials to resolve and identify trends and provides feedback to providers and departments.  Performs quality assurance reviews of inpatient and outpatient records to assess and report on the effectiveness of training programs and quality of coders.  Provides in-service training and feedback to coding staff regularly, including coding changes and updates.  Oversees coding operations to ensure organizational goals are being met. Partners with the Coding Education Team to design and implement programs on coding and clinical documentation audit and education to improve performance and efficiency.  Enforces correct application of Official Coding Rules and Regulations and follows appropriate guidelines.  Oversees the coding edits and denials and ensures compliance with payer guidelines.  The Manager, PB Coding Operations is responsible for supporting coding related, RAC, other external coding reviews, and denials related to coding.

ESSENTIAL RESPONSIBILITIES / DUTIES:

Primary responsibilities under the direction of the Director, PB Coding Operations:

Coding support

• Reviews patient medical records and abstracts medical data that identifies all diagnoses and procedures.  Codes diagnoses, procedures, and appropriate modifiers from the medical record documentation using ICD-10-CM, CPT4/HCPCS classification systems.  Refers to a computerized encoding system, written coding aids and other reference materials to ensure accurate coding for billing. 

• Sequences diagnoses, procedures and complications by following ICD-10-CM, CPT-4, and the Uniform Hospital Discharge Data Set (UHDDS); adheres to the Official Guidelines for Coding and Reporting, Coding Clinic guidelines and other regulatory guidelines as appropriate. Consults with appropriate medical staff to clarify medical record information.

• Maintains productivity standards set forth in Departmental Policies and procedures. 

• Serves as contact for professional billing coders regarding missing/incomplete information to allow for accurate billing in a timely manner.

• Maintains knowledge of coding and professional skills, including maintaining yearly coding credentials through attendance at in-service programs, conferences, workshops, review of current literature and other educational programs.

• Assists in orienting new personnel in department coding procedures.

• Monitors all coding ques to ensure productivity is being kept on target.

• Performs other duties as needed.

• Review and respond to coding questions. 

• Ensure billed service is being accurately coded.

• Perform random chart audits.

• Perform analysis of benchmarking profiles.

• Provide continual coding updates.

• Research coding issues that arise.

• Codes diagnoses and procedures from the medical record using ICD-10-CM and CPT-4/HCPCS classification systems. 

• Sequences diagnoses, procedures and complications by following ICD-10-CM, Medicare, Medicaid, and other fiscal intermediary guidelines.

• Reviews charts for documentation and signature.

General

• Responsible for the day-to-day management of the PB Coding Operations Team.

• Duties include managing, developing and mentoring a group of certified professional coders.

• Other responsibilities include interviewing, orientation, training and preparing evaluations; responsible for hiring, terminating and disciplining personnel as necessary.

• Establishes staffing scheduling and assigns workloads and projects in accordance with appropriate volume increases and decreases.

• Assists with coding all professional claims under the direction of the PB Coding Operations Team.

• Conducts quality reviews to validate code selection is compliant with established coding guidelines.

• Evaluates documentation for incomplete or inconsistent documentation in the record which impacts code assignment.

• Initiates queries when necessary and monitors responses.

• Provides training to healthcare professionals, coders, and Revenue Cycle staff in ICD, CPT, HCPCS Level II coding guidelines, proper documentation guidelines and other information related to coding.

• Develops long term strategies for improving efficiencies and increasing coding team’s productivity through use of central coding conventions and classification systems, influencing and educating the coding team as well as all revenue cycle stake holders.

• Reports on accuracy of coding and abstracting.

• Responsible for the tracking and response for coding accountabilities from internal and external sources. This would include RAC coding reviews as well as other payer reviews.

• Tracks overtime, absenteeism, hours worked, leaves and vacation/sick time for assigned staff.  Reviews and approves timesheets to Payroll.

• Maintains knowledge of ICD-10 and CPT classifications and coding of diagnoses and procedures.

• Participates in coding and reimbursement meetings.

• Follows established hospital infection control and safety procedures.

• Maintains professional skills and knowledge of coding through attendance at in-service programs, conferences, workshops and other educational programs and by review of current literature.  Shares knowledge and learning experiences to staff.

• Performs other related duties as required.

JOB REQUIREMENTS

EDUCATION:

Bachelor’s degree or equivalent combination of formal education and experience.

CERTIFICATES, LICENSES, REGISTRATIONS REQUIRED:

CPC – Certified Professional Coder

EXPERIENCE:

• Must have at least five years of experience in coding; experience must include education/mentoring/training.  Minimum of five years acute care hospital experience coding with ICD-10-CM and CPT-4, academic medical setting or trauma center preferred.  Minimum of three years management experience required; five years preferred.

• Prior experience working claim edits and denials.

KNOWLEDGE AND SKILLS:

• Excellent command of the ICD-10-CM and CPT4/HCPCS coding conventions, E&M coding.  Work also requires concepts of human anatomy, physiology and pathology.

• Excellent skill in providing hands-on education to PB Coding Operations staff based on audit finding and need. 

• Strong knowledge of health records, computerized billing and charging systems, Microsoft applications, data integrity, and processing techniques required. 

• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.

• Ability to work with accuracy and attention to detail

• Ability to solve problems appropriately using job knowledge and current policies/procedures.

• Ability to work cooperatively with members of the healthcare delivery team and staff, ability to handle frequent interruptions and adapt to changes in workload and work schedule and to respond quickly to urgent requests.

• Must be able to maintain strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

• Must possess extensive knowledge of hospital inpatient and outpatient reimbursement methodologies.

• Strong knowledge of health records, computer systems, Microsoft applications, data integrity, and processing techniques required.

• Ability to mentor, guide and motivate direct reports through demonstration of best practices and leading by example.

• Excellent organizational skills, including ability to multi-task, prioritize essential tasks, follow-through and meet timelines.

• Ability to solve problems appropriately using job knowledge and current policies/procedures.

• Ability to maintain and enforce strict confidentiality of all personal/health sensitive information and ensure compliance of HIPAA rules and regulations.

• Must possess extensive knowledge of payer claim edits and payer denials.  Work requires in-depth knowledge of medical terminology, ICD-10-CM and CPT-4 Coding conventions (including E&M coding),  CMS National Coverage Determinations and various other applicable coding regulations and law.

Equal Opportunity Employer/Disabled/Veterans

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