Market Coding Manager for Rock Hill, SC job – Tenet Physician Resources – Dallas, TX

Market Coding Manager for Rock Hill, SC

Tenet Physician Resources

3 reviews

Dallas, TX

POSITION SUMMARY: Provide oversight for the day to day coding operation activities for individual TPR market. Serve as a Coding Operations Subject Matter Expert (SME) to answer coding operation questions, ensure coding compliance within individual TPR market and ensure accurate, timely claims submission. Responsibilities: Serve as coding SME including but not limited to basic E&M, specialty specific surgery coding and ICD-9/ICD-10 -CM for practices within his/her individual market; Work with providers, coders, billers, clinical and non-clinical office staff to answer coding questions and provide guidance, as needed; Work with the Coding Operations and Clinical Operations Performance Standards teams and market coding team to complete pre-bill clearance audits and ensure feedback is given to physicians and coders in a timely manner so bill holds can be released within a 60 day or less window of onboarding; Monitor market bill hold reports and market new provider start dates to ensure the pre-bill clearance process is performed for all new providers; Maintain a grid indicating providers who have been “cleared” to bill by Clinical Operations Performance Standards team and compare grid to the daily Nextgen or other EPM/EHR system bill hold report to ensure “cleared” providers are no longer in a bill hold status and investigate and resolve discrepancies; Work with Regional and/or National Coding Operations Manager to perform coder QA assessments for new coders or coders assigned to a new specialty; Monitor compliance central for remediation plans, etc. for individual market coders and/or biller, as necessary; Collaborate with Coding Educator, if applicable, to run quarterly E&M code utilization reports to monitor provider coding patterns and conduct spot checks of documentation for providers whose E&M patterns deviate from the norm; Perform annual provider E&M documentation reviews of 5 encounters for all providers in the markets to ensure accurate selection of evaluation and management and procedure codes to be in compliance with Medicare, Medicaid and other payer requirements; Collaborate with Coding Educator, is applicable, to develop provider education, as needed, based upon these reviews; Oversee the day to day coding operations of the market by monitoring pending charges, kept appointments with no charges and task reports, etc. to ensure coders and/or billers are clearing their work ques in a timely manner. Keep Regional Coding Operations Manager informed of any issues that prevent timely submission of claims; Assist individual market coding staff with day-to-day coding duties, as needed, including but not limited reviewing provider documentation to ensure assignment and sequencing of procedural and diagnostic codes to ensure accurate and timely submission of claims; Assist market coding staff work coding tasks, as needed, to ensure timely processing of payer denials and adherence to RCM KPI metrics; Ensure market coding resources have the tools necessary to successfully perform their task (coding books, coding software, access to sharepoint for newsletters, etc.) Participate with special projects and other duties as assigned Performs duties while demonstrating strong, interpersonal and communication skills that allows work to flow in a positive, constructive, and professional manner. Works with all team members to facilitate congenial and professional working relationships with subordinates, peers, and superiors thus creating a harmonious work environment. Ensures that all contacts with patients, senior leadership, managers, the public, physicians and other personnel are carried out in a friendly, courteous, helpful and considerate manner. Answers telephones in a prompt and courteous manner. Displays concern and provides assistance or explains procedures as appropriate to callers or in face-to-face situations. Dedicated to meeting the expectations and requirements of internal and external customers. Works with customers to identify problem areas and recommend solutions. Knowledge of Federal laws and regulations affecting coding requirements. Extensive knowledge of official coding conventions and rules established by the AMA and CMS for assignment of diagnostic and procedural codes. POSITION QUALIFICATIONS (including required licenses/certifications, education and job knowledge/experience): Must have a high school diploma or equivalent. Associate’s degree in related field preferred Completion of college level courses in medical coding/billing, medical terminology, anatomy and physiology, highly desirable. Must be certified through the American Academy of Professional Coders (AAPC) as a Certified Professional Coder (CPC), Preferred OR Must be certified through the American Health Information Management Association (AHIMA) as a Certified Coding Specialist Physician Based (CCS-P) Minimum of five years’ experience in a medical Coding position, including three years’ experience in a management role. Expert working knowledge of CPT-4, ICD9, ICD-10-CM and HCPCS codes as well the National Correct Coding Initiative (NCCI) edits Strong understanding of coding and documentation issues facing the healthcare industry Remains current on reimbursement regulations and coding guidelines and keeps the market informed of changes; Working knowledge of Microsoft Office products. Ability to analyze data Skilled in exercising initiative, judgment, problem solving and decision making. Good communication skills and ability to effectively manage staff. Job: Medical Coding Primary Location: Dallas, Texas Hospital Location: Tenet Physician Resources Job Type: Full-time Shift Type: Days


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