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Job Summary:
The Director of Coding is responsible for the oversight of daily operations of affiliate practice coding, audits, creating and updating SOPs and team coding documentation, and staying on top of coding updates. The position manages coding review and data entry functions necessary for accurate and timely coding and input of daily charges. Ensures coding services meet productivity and quality standards to support the financial goals of the organization. Responsible for identifying, evaluating regulatory questions or issues related to the coding and billing of patient claims and services. This role will support the comprehensive strategy and growth plans to ensure that the coding team has a robust and proactive compliance program.
Essential Duties:
- Provide leadership to coding review and charge capture staff. Ensure that equity of workloads, productivity goals and assignments are maintained. Assigns monthly benchmarks, weekly activities and daily priorities as appropriate to ensure timely completion of duties
- Establish protocols to ensure Revenue Integrity
- Plan and direct audits to evaluate the adequacy and accuracy of documentation in support of services billed, including CPT/ICD-10/HCPCS and other third-party payer codes, medical necessity of services, compliance with other documentation and coding and billing standards
- Lead the evaluation of the adequacy and effectiveness of internal and operational controls designed to ensure that processes and practices lead to appropriate execution of regulatory requirements and guidelines related to coding and billing, federal and state regulations and guidelines, CMS and other third-party payer billing rules, and OIG compliance standards
- Establish and implement a physician education program to include documentation education
- Serve as a subject matter expert and authoritative resource on interpretation and application of documentation and coding rules and regulations, and conduct enterprise risk assessments of potential and detected compliance deficiencies
- Stay current on relevant coding and billing regulations and enforcement trends, specifically as they relate to provider-based coding and billing to include updates to key stakeholders
- Develop standards and guidelines for medical record documentation including reporting on deficiencies and training to remediate
- Collaborate with Compliance Officer on compliance, coding documentation and risk management when required
- Partners with Chief Medical Officer on all coding related projects including but not limited to physician education, updated coding rules and best practices, research, etc.
- Develop the annual compliance work plan sections relating to coding and billing
- Work closely with company’s physicians, Operations and Revenue Cycle Leadership to validate controls and monitor high risk areas
- Perform coding and billing documentation and charge audits, according to best practices
- Responsible for coaching, professional development, and mentoring coding and data entry staff
- Develop documented policies and processes related to the management of coding and billing compliance matters
- Develop edits within claims scrubber EHR software including testing and validation
- Prepare and provide coding education to organization physicians, providers and staff
- Responsible for effective identification of staffing resources, recruitment, and allocation of resources
- Provide guidance and motivation to staff regarding identification of activities/areas where performance can be improved
- Responsible for making recommendations and/or decisions for hiring, corrective actions, terminations, and performance evaluations
- Other duties as assigned by the Vice President of Revenue Cycle Management
Required Qualifications:
- Certified Professional Coder- AAPC Certifications
- Coding compliance experience
- Bachelor’s degree or equivalent work experience
- Orthopedic physician practice and/or surgery center experience
- Advanced Knowledge of:
- Documentation, coding and billing rules/guidelines
- CPT/ICD-10/HCPCS coding rules
- Medical terminology and healthcare compliance audit requirements
- CMS regulations and guidelines
- Minimum of 10+ years of management experience in a physician or healthcare MSO organization
- Ability to manage and direct others in a fast-paced, team-oriented environment including remote indirect and direct reports
- Independent judgment; effective, team-oriented leadership skills.
- Excellent analytical, problem-solving and decision-making skills
- Excellent communication skills (verbal, written & presentation)
- Excellent computer skills with strong proficiency in reporting, spreadsheet applications and experience with Microsoft Office
- Travel up to 25% as needed for practice support, coding audits, learning and development, coding team member coaching, etc.
- The role is based in the Alpharetta, GA, office which follows a hybrid work structure where employees can work remotely or from the office, as needed, based on demands of specific tasks or deadlines, as determined by the manager. Working from the office is encouraged, at times required, for tasks that require a high degree of collaboration.
Preferred Qualifications:
- Certified Orthopedic Surgery Coder
Location: remote,
Type: Direct Hire
Pay: Apply for details
1694