Coding & Compliance Manager, Surgery

Job description

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives. This position is responsible for facilitating the coding, auditing and billing process according to CMS, BIDMC, other federal insurance programs, third-party billing and compliance regulations and guidelines. Oversees and directs efforts across the Department of Surgery to streamline the compliant coding and revenue cycle process with the ultimate goal of optimizing the reimbursement process. Job Description: Primary Responsibilities: 1. Oversees the scope, direction, and effectiveness of the coding team in supporting and maintaining the department billing protocols, standards, compliant coding and needs. Provides guidance to coders and audits work as needed to assure accuracy. (essential) 2. Develops and implements coverage models including cross-training staff to multiple specialties; ensures defined expectations and coding consistency. Communicates all pertinent and changing regulations to team, faculty, and divisions within the department. Leads weekly/monthly meetings to review and update staff. (essential) 3. Samples medical documentation to ensure coding and billing compliance within the department to identify possible trends and training needs and/or areas that require performance/process improvement. Researches and analyzes data, draw conclusions, and resolve issues. (essential) 4. Monitors, proposes, and minimizes billing and coding operational inefficiencies by reviewing accuracy and production levels and communicating data analysis on audit trends, scrubber data, government audit requests, denials/appeals as well as developing and implementing corrective action plans for setting performance targets. (essential) 5. Presents audit results to appropriate recipient(s) and conducts presentations/training sessions. Develops and administers ongoing physician, fellow and nurse practitioner education training sessions including documentation guidelines, new/revised/deleted codes, medical necessity and modifier principles. (essential) 6. Plans and oversees the daily work activities of the coding team and provides ongoing feedback regarding training needs, staff performance and process improvement. May provide recommendations to Director on hiring, terminations and corrective action as well as contributing feedback during the performance review process. (essential) 7. Serves as point person for all HMFP audits of medical documentation and post payment audits. Responsible for working with HMFP Compliance and the department, providers and billing services to ensure compliant billing and documentation is promoted throughout the department. (essential) 8. Provides coding services to the division(s). Works with the billing service to resolve denials and other billing issues. (essential) 9. May perform additional job duties as time permits, such as: ensuring appropriate compliance and attainment of projected revenue cycle goals; collaborating to streamline revenue cycle process with the goal of optimizing the reimbursement process; verification of compliance accuracy related to E&M and procedural coding, documentation requirements and chargeticket entry/billing process. (essential) 10. May perform additional job duties as time permits, such as: developing and presenting performance metric reports with a review of findings with Attending Physicians, Directors, Managers and Chiefs; service on committees; maintains relationship with third party billing companies to ensure continuous excellence in services; fosters relationships with affiliates related to coding and compliance. (essential) Required Qualifications: 1. High School diploma or GED required. Bachelor's degree preferred. 2. Certificate 1 Certified Professional Coder required. 3. 5-8 years related work experience required. 4. Advanced skills with Microsoft applications which may include Outlook, Word, Excel, PowerPoint or Access and other web-based applications. May produce complex documents, perform analysis and maintain databases. Preferred Qualifications: 1. Certified Professional Compliance Officer (CPCO) Competencies: 1. Decision Making: Ability to make decisions that are guided by precedents, policies and objectives. Regularly makes decisions and recommendations on issues affecting a department or functional area. 2. Problem Solving: Ability to address problems that are highly varied, complex and often non-recurring, requiring staff input, innovative, creative, and Lean diagnostic techniques to resolve issues. 3. Independence of Action: Ability to set goals and determines how to accomplish defined results with some guidelines. Manager/Director provides broad guidance and overall direction. 4. Written Communications: Ability to summarize and communicate in English moderately complex information in varied written formats to internal and external customers. 5. Oral Communications: Ability to comprehend and communicate complex verbal information in English to medical center staff, patients, families and external customers. 6. Knowledge: Ability to demonstrate in-depth knowledge of concepts, practices and policies with the ability to use them in complex varied situations. 7. Team Work: Ability to lead collaborative teams for larger projects or groups both internal and external to the Medical Center and across functional areas. Results have implications for the management and operations of multiple areas of the organization. 8. Customer Service: Ability to provide a high level of customer service and staff training to meet customer service standards and expectations for the assigned unit(s). Resolves service issues in the assigned unit(s) in a timely and respectful manner. Social/Environmental Requirements: 1. Work requires close attention to task for work to be accurately completed. Intermittent breaks during the work day do not compromise the work. 2. Work is varied every day and the employee needs to be adaptable to respond to these changes and use independent judgment and manage priorities. 3. No substantial exposure to adverse environmental conditions 4. Health Care Status: NHCW: No patient contact.- Health Care Worker Status may vary by department Sensory Requirements: Close work (paperwork, visual examination), Color vision/perception, Visual monotony, Visual clarity Physical Requirements: Sedentary work: Exerting up to 10 pounds of force occasionally in carrying, lifting, pushing, pulling objects. Sitting most of the time, with walking and standing required only occasionally This job requires constant sitting, Keyboard use.There may be occasional Fine Manipulation using one hand. Pay Range: $92,955.00 USD - $125,091.00 USD The pay range listed for this position is the annual base salary range the organization reasonably and in good faith expects to pay for this position at this time. Actual compensation is determined based on several factors, that may include seniority, education, training, relevant experience, relevant certifications, geography of work location, job responsibilities, or other applicable factors permissible by law. As a health care organization, we have a responsibility to do everything in our power to care for and protect our patients, our colleagues and our communities. Beth Israel Lahey Health requires that all staff be vaccinated against influenza (flu) as a condition of employment. More than 35,000 people working together. Nurses, doctors, technicians, therapists, researchers, teachers and more, making a difference in patients' lives. Your skill and compassion can make us even stronger. Equal Opportunity Employer/Veterans/Disabled