Sr Manager, Coding Auditing & Education (IP & OP Facility)

About Us:

Our purpose is to help clients exceed their financial health goals. Across the reimbursement cycle, our scalable solutions and clinical expertise help solve programmatic needs. Enabling our teams with leading technology allows analytics to guide our solutions and keeps us accountable achieving goals.

We build long-term careers by investing in YOU. We seek to create an environment that cultivates your professional development and personal growth, as we believe your success is our success.

JOB SUMMARY:

ESSENTIAL DUTIES AND RESPONSIBILITIES:
Note: The essential duties and responsibilities below are intended to describe the general duties and responsibilities of this position and are not intended to be an exhaustive statement of duties. This position may perform all or most of the primary duties listed below. Specific tasks, responsibilities or competencies may be documented in the Team Member’s performance objectives as outlined by the Team Member’s immediate Leadership Team Member.

The Senior Manager, Coding Audits and Education, is responsible for leading Audits and Education Specialists (“Auditors”) who provide hospital and provider auditing to external customers. Must have the ability to accurately audit and code (ICD-10-CM, ICD-10-PCS, CPT, HCPCS, modifiers, NCCI edits, etc.) of the following hospitals and/or provider-based facilities. The Sr. Manager will be working with multiple facility specific billing and coding guidelines as well as various Medicare Administrative Contractors nation-wide. The position interacts with clients on a frequent basis and must be able to present audit findings in a professional and educational manner.

Job Description Essential Functions:

• Directs audit team to complete external audits by prioritizing and organizing projects to ensure completion within required timeframes.
• Responsible for preparation and presentation of the coding audit to the client and coding team including participation in rebuttals.
• Interview, hire and train Audit and Education Specialists (Auditors).
• Monitor and evaluates auditor performance and carries out improvement activities. Ensure auditors meet 95% or higher quality standards.
• Collaborate with sales to complete proposals, participate in new customer discovery, and scheduling of new client activities.
• Responsible for analyzing, reviewing and resolving coding and documentation issues that are related to reimbursement, compliance and revenue enhancement for each client.
• Reviews and approves employee timecards as appropriate.
• Monitors and maintains multiple project budgets to ensure financial accuracy and timely completion. Ensures expenditures align with financial plans and project timelines.
• Implements ad hoc audit requests from clients as needed.
• Participates in finance routine calls reviewing budget and projections.

Required Knowledge, Skills & Abilities:

• Five (5) years’ supervisory experience.
• Ten or more years’ experience with coding audits. This should include facility and provider audits.
• Must have one or more active credentials from AHIMA and/or AAPC: CCS, CCS-P, CPC, CPMA, RHIA or RHIT). Prefer the following: CCS or COC preferred for facility outpatient; CPC of CPMA required for Professional Fee.
• Strong working knowledge of ICD-10-CM, ICD-10-PCS, MS DRG and APR DRG assignments, CPT, HCPCS and applicable NCCI edits.
• Working knowledge of Medicare and other regulatory guidelines.
• Experience with multiple electronic medical record systems and encoders required.
• Strong analytical skills and attention to detail.
• Proficient computer skills, specifically Microsoft Office products.
• Strong written and verbal communication skills.
• Ability to work simultaneously with multiple and diverse clients and projects.
• Assure that work product is completed with high levels of accuracy and attention to detail.
• Make well-informed, effective, and timely decisions, even when data are limited, or solutions produce unpleasant consequences; perceive the impact and implications of decisions.
• Clearly express information (for example, ideas or facts) to individuals or groups effectively, considering the audience and nature of the information.
• Work with internal and external customers to assess their needs, provide information or assistance, resolve their problems, or satisfy their expectations.
• Contribute to maintaining the integrity of the organization; display high standards of ethical conduct and understand the impact of violating these standards on an organization, self, and others.
• Be open to change and new information; adapt behavior or work methods in response to new information, changing conditions, or unexpected obstacles; effectively deal with uncertainty.
• A high level of effort and commitment towards performing the work, using efficient learning techniques to acquire and apply new knowledge and skills; uses training, feedback, or other opportunities for self-learning and development.

Display courtesy, empathy, and tact, developing and maintaining effective relationships with others; effectively work with individuals who are difficult, hostile, or distressed to resolve differences; and be able to relate well to people from varied backgrounds and in different situations.

PHYSICAL DEMANDS:
Note: Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions as described. Regular eye-hand coordination and manual dexterity is required to operate office equipment. The ability to perform work at a computer terminal for 6-8 hours a day and function in an environment with constant interruptions is required. At times, Team Members are subject to sitting for prolonged periods. Infrequently, Team Member must be able to lift and move material weighing up to 20 lbs. Team Member may experience elevated levels of stress during periods of increased activity and with work entailing multiple deadlines.
A job description is only intended as a guideline and is only part of the Team Member’s function. The company has reviewed this job description to ensure that the essential functions and basic duties have been included. It is not intended to be construed as an exhaustive list of all functions, responsibilities, skills and abilities. Additional functions and requirements may be assigned by supervisors as deemed appropriate.