What are the responsibilities and job description for the Coding Manager position at Cardiovascular Logistics?
GENERAL NATURE OF DUTIES:
Responsible overseeing the clinic and hospital coding practices and documentation of medical information as it pertains to reimbursement, compliance and quality assurance. This individual must work closely with the Practice Administrators, Business Office, and Hospital Partners and communicate effectively with the billing managers, nursing staff and medical staff regarding coding, documentation and compliance issues. This coordinator will also train/instruct and coach the clinic and hospital coding personnel in proper coding practices.
SPECIFIC DUTIES:
Compliance, Coding, Documentation and Reimbursement Activities:
- Supervises and performs a wide range of activities pertaining to the review and coding of inpatient and outpatient medical record information.
- Assist Practice Administrators with allocation of coding resources across all clinics to ensure coverage to meet month end deadlines.
- Assist hospital partners with coding consistency and/or other information on and an ongoing basis.
- Performs data quality reviews on inpatient records to validate the International Classification of Diseases Manual (ICD-10), the Current Procedural Terminology (CPT), and the Healthcare Common Procedure Coding System (HCPCS) Level II code and modifier assignments; verifies appropriateness; checks for missed secondary diagnoses and procedures and ensures compliance with all diagnosis mandates and reporting requirements; monitors Medicare and other bulletins and manuals, and reviews the current Office of the Inspector General (OIG) work plans for diagnosis risk areas.
- Participate in the MACRA team (not sure what this team is or if it still exists). Train/instruct and coach staff in proper coding practices to strengthen risk-adjusted coding.
- Assist the coding and billing department in determination of proper indications for services.
- Maintain a current written policy and procedure Coding Manual to secure accurate, consistent and compliant coding and billing practices.
- Provide an up-to-date resource for providers and staff to review proper Medicare indications for services. Assist with maintaining an electronic Medicare resource on “shared data” for quick access to current Medicare information by staff and/or providers.
- Assist in the review and resolution of medical necessity denials. Provide medical information on claims requiring such to be processed.
- Assist with the development of and implementation of an internal coding audit program.
- Complete internal documentation, billing and compliance audits on a reoccurring basis. Obtain information, through chart reviews and data studies, to assess medical documentation of reimbursement, compliance and risk management issues.
- Communicate findings to the Business Services Director, Practice Administrators, and Providers and assist in communicating the findings and need for improvement in medical documentation.
- Assure education of nurses, staff and providers across CIS on documentation requirements, coding and billing practices, Medicare policies and procedures and compliance rules.
- Attend workshops and seminars to assure up-to-date information of topics that apply to coding, billing and compliance.
- Review no less than once a quarter the E&M Analysis to look for education opportunities for providers.
- Present to all coders at least once a quarter some type of coding education for clinic or hospital or both based on recent audit findings.
- Assist in the development and on-going review of coding productivity to ensure that productivity levels remain at or above Med Axiom benchmarks.
Quality and Risk Management Monitoring and Education
- Work closely with office team leaders and staff to assure consistency of coding and billing practices, documentation and compliance activities. Answer questions and give guidance as needed.
- Review annual Medicare quality and cost data reports to determine areas of opportunity.
- Works in harmony with CIS Compliance to assure that all coding is being done in a compliant manner and that issues related to compliance and coding are being addressed in a timely manner.
Other duties:
Performs other related duties as assigned and serves in whatever other capacity deemed necessary for successful completion of the mission and goals of CIS and in concordance with its patient philosophy.
QUALIFICATIONS FOR THE POSITION:
- Bachelor’s Degree preferred.
- Excellent communication and organization skills required.
- Ability to travel to all CIS locations.
- Willingness to cooperate and work towards solutions, which support a common goal.
- Staff education experience preferred.
- Ability to work independently with minimal supervision.
- Experience with Medicare process, reimbursement, audit and compliance issues.
- Certified Professional Coder (CPC) preferred
