Company :Allegheny Health Network
Job Description :
Plans, directs, organizes, and controls the coding across multiple facilities to ensure timely coding for billing and coding compliance. This position is part of a leadership role in a high-profile team tasked with ensuring consistent and quality coding from discharge to final bill generation and resolution. The manager must maintain advanced knowledge of revenue cycle processes to aid in the implementation of regulatory standards that assist in coding while accurately complying with billing guidelines. This includes extensive knowledge of all aspects of the revenue cycle including the registration, coding, billing and collection processes as well as government and payor regulations for both professional and facility billing. The manager is responsible for the analysis and assessment of diverse data relating to the revenue cycle. Acting as an internal consultant, the manager provides essential quality reports, and advice and improvement recommendations to management along all service lines. Manager is required to understand and communicate complex issues and changes relating to regulatory compliance to the department(s) involved, maintaining records of their notification, accountability and compliance. Works closely with hospitals and service line departments to provide accurate, critical information for identification of areas needing immediate attention to improve revenue results.
- Manage, set vision, and define roles and responsibilities for coders, including training, delegating tasks, overseeing daily activities, mentoring, guiding through demonstration of best practices and offering opportunities for professional development. Ensures the highest standards for the hiring selection, training, orientation and assignments of department staff. Provides leadership to coders reporting to management staff with regards to the evaluation, promotion and resolution of employee relations/disciplinary concerns and the termination of employees, if necessary. (25%)
- Assures timely and accurate coding / abstracting to comply with regulatory agencies and fiscal intermediaries and meets turnaround time. Assures validation process required by external agencies. (20%)
- Facilitate the dissemination of information regarding government and payor regulations/requirements to clinical departments, providers, management and staff, as applicable. Oversees communication of coding updates to all stakeholders as appropriate. (20%)
- Assures that audited records are coded correctly, appealed if appropriate, follow-ups on process, and identifies education issues. Educates staff, , registration and medical record staff regarding coding compliance and clinical documentation. (15%)
- Administers the computer system, and coordinates database requests for reports. (10%)
- Designs, implements and maintains quality control measures and productivity monitors. (5%)
- Performs other duties as assigned. (5%)
- Coding certification from a certifying body AAPC(American Academy of Professional Coders) or AHIMA(American Health Information Management Association)
- Bachelor’s Degree or 6 years of experience in lieu of Bachelor’s degree
- 3 years in a management role in multi-physician medical practice or facility/billing business office
- 3 years with coding, encoder, grouper, abstracting, registration and billing systems
- Excellent computer skills
- Experience in an academic medical center.
- Knowledge of JC, DOH, CMS and other regulatory standards
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement : This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:$33.81
Pay Range Maximum:$52.90
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
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