Reliant Medical Group is seeking a Coding Manager in our Rev Ops department to join our exciting and innovative organization!
Full Time: 40 hrs
Hours: Monday - Friday 8:30AM - 5:00PM (Flexible)
Responsible for all aspects of coding, charge entry and coding denial follow up. Manages the daily activities and processes of assigned staff and the training, development and streamlining of policies and procedures and workflow, staff productivity, quality of work and related duties. Communicates coding issues and initiatives with Revenue Operations, IT and Clinical Operations staff including Directors, Managers, Leads, Physicians and Allied Health Providers.
Assures that coding and charge entry functions are performed accurately, efficiently and timely in accordance with regulations, department goals and carrier contracts as well as Corporate Targets and month end/year end requirements.
Manages and maintains an efficient work process with an emphasis on automation and maximizing Epic Resolute Billing and clinical coding use of the EpicCare electronic health record (from a coding perspective).
Integrates with Optum, all specified coding compliance data as required under Optum Coding Compliance Policies/Procedures.
Manages lag time from date of service to charge entry for all points of service.
Measures and ensures staff productivity and accuracy within established standards.
Assures the coding and charge entry process system-wide is compliant with governmental and payer guidelines.
Ensures that ICD, HCPCS and CPT coding are kept up-to-date and accurate.
Expands and improves on coding training and education sessions for the coding/charge entry staff, Revenue Operations staff and all RMG/SMG providers.
Manages Coding related rejections/denials via Coding follow-up, ensuring that accounts receivable days are minimized and revenues are maximized. Works collaboratively with payers to resolve outstanding coding related A/R concerns and improve processes. Ensures timely accurate appeals and resolution of coding-related denials received from Insurance or governmental carriers.
Keeps abreast of Coding and reimbursement regulations and other industry guidelines and changes. Communicates changes accordingly.
Works collaboratively with coding staff and RMG IT Dept on yearly upload of ICD, CPT and HCPCS Codes.
Works closely with physicians, internal and external managers, administrators, team leaders and others to ensure that billing is optimized and is performed with-in regulatory guidelines.
Creates and maintains efficient work processes with emphasis on automation and maximizing the use of the Billing System. Tracks/Trends reasons for coding denials and recommends/implements change to reduce volumes.
Measures and ensures optimal staff productivity and accuracy. Resolves discrepancies as required or directed.
Monitors assigned staff work-queue volumes to ensure productivity and quality of work and to identify areas requiring re-allocation of resources.
Meets with Clinical Operations, Managers, Team Leaders, Information Technology or others to ensure integration of revenue cycle activities.
Collaborates with payors and with internal/external parties to resolve issues at a global level and expedite maximum reimbursement.
Collaborates with contracting to ensure accuracy and optimization of reimbursement and communication of contractual issues as they relate to coding compliance.
Bachelor’s Degree in Business Administration, Healthcare or related field. Minimum of five (5) years health care Management experience in a multi-specialty physician group practice, billing agency or Hospital.
Coding Certification required (CPC, CCS-P, etc)
Demonstrated experience in professional billing environment/physician billing, reporting and revenue cycle including utilization of practice management systems and analytics.
Demonstrated experience in Revenue Cycle Analytics. Must be proficient in use of Excel.
Thorough knowledge of Medicare and Massachusetts third party payer requirements and billing compliance regulations.
Understanding of Capitation and Global Risk Contracting Agreements/Billing
Demonstrated knowledge of insurance rules and regulations and claims submission
Excellent interpersonal, organizational, and communication skills. Epic Resolute comprehension required within 12 months of start date.