XTN-B788447 | CODING QUALITY MANAGER

The Coding Quality Manager is responsible for developing and implementing coding audit monitoring and education activities for providers and coders, in support of the organization’s adherence to applicable CMS requirements, official coding guidelines, government regulations and internal policies.   Manages and directs a team of Coding Audit Educators.  Serves in an advisory capacity to leadership and physicians as it relates to documentation, coding, and regulatory compliance.

• Annual incentive plan, HMO entitlement with 2 dependents upon hire, 20 days leave credit with 5 days monetization for unused credit
• Health Insurance/HMO
• Enjoy unlimited MadMax Coffee
• Diverse learning & growth opportunities
• Accessible Cloud HR platform (Sprout)
• Above standard leaves

• Develops and oversees ongoing coding quality audit program for provider services encounters.
• Identifies high risk areas, plans, and executes audit monitoring activities to evaluate compliance with laws, regulations, policy and procedures, coding and billing standards, etc.
• Creates and implements standardized audit monitoring methodology and oversees team’s adherence to goals and scheduled audits.
• Develops presentations and delivers education sessions to providers, coders, and other members of revenue cycle teams.  Conducts one-on-one and group sessions with providers and other members of the organization via teleconferencing platforms.  Coaches team members to perform provider education sessions.
• Responsible for leadership, direction, and work product of Coding Auditor and Educator team.
• Ensures that the coding quality team stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding.  Reviews AHA and CPT quarterly coding update publications.
• Assists other departments within the organization with coding questions, reviews, or inquiries.
• Reviews and prepares response to external payer and compliance audits, including but not limited to RAC, payer audits, and external compliance audits.
• Understands, interprets, and applies coding guidelines for coding.
• Stays current with Official Coding and Reporting Guidelines, CMS and other agency directives for ICD-10-CM/PCS and CPT coding. Completes online education courses and attends mandatory coding workshops and/or seminars (ICD-10 and CPT updates) for Physician Services coding. Reviews AHA and CPT quarterly coding update publications.

• 3- 4+ years orthopedic surgery and/or Evaluation and Management (E/M) coding audit experience required.  Other surgical specialties considered.
• 2+ years supervisory or manager experience required.
• Must have current CPC, CPMA, COSC or CEMC certification from AAPC.  Will consider CCS-P or CCS certification from AHIMA, with relevant work experience.
• Associate degree in health information management, health services administration, or related field desired.
• Proficiency in MS Office products - intermediate to advanced knowledge of MS Excel.
• Must successfully pass pre-hire coding assessment.
• Strong technical knowledge of Centers for Medicare & Medicaid Services (CMS) regulatory guidelines, including ICD-10 CM, CPT, and HCPCS Procedure Coding, and official coding guidelines.
• Knowledge of disease pathophysiology and drug utilization.
• Knowledge of NCCI edits structures.
• Must be detail oriented and have the ability to work independently.
• Computer knowledge of MS Office, including Word and Excel.
• Must display excellent interpersonal skills.
• Ability to demonstrate initiative and discipline in time management and assignment completion.
• Ability to work in a virtual setting under minimal supervision.

Additional relevant knowledge or experience related to the above requirements will be considered an advantage.