Manager, RCM Coding Compliance

Why join us? This is an exciting time to join OneOncology. Our values-driven culture reflects our startup enthusiasm supported by industry leaders in oncology, technology, and finance. We are looking for talented and highly-motivated individuals who demonstrate a natural desire to improve and build new processes that support the meaningful work of community oncologists and the patients they serve.

Job Description:

The Manager, RCM Coding Compliance & Denials, will be responsible for overseeing the shared services coding denials and recoupment analysts, and managing the denials process within the organization. This role will report to the RCM Coding Director and will monitor coder compliance by utilizing QA audits and trending analyses. It will ensure that the company adheres to all relevant regulations and standards, and effectively manages and resolves claims denials to optimize revenue cycle performance.

Responsibilities:

• Manage the day-to-day oversight of the Shared Services Coding Denials team.
• Develop policies and procedures, and ensure corporate compliance with billing policy and procedures are met.

• Develop and implement strategies to prevent and reduce denials, and improve the efficiency of the claims process.
• Work closely with the Shared Services Coding and Billing Managers to collaborate on claim edits designed to prevent back-end denials and offsets.
• Routinely review QA audit feedback from the Coding Quality Assurance team and help identify the root cause of denials.
• Ensure timely and accurate submissions for denied claims.
• Collaborate with Coding Leadership any trends and issues identified by the team and implement coaching, process improvement opportunities, and corrective action plans based on Company policies and coding principles.
• Manage employee relations issues including hiring, discipline, coaching and performance evaluations.
• Stay current with industry trends and regulatory changes, including payer policies and disseminate relevant information to the CoE leadership team.
• Work effectively with offshore staff, ensuring clear communication, alignment of goals, and adherence to compliance standards across all teams.
• Collaborate with the Coding CoE leadership team and the OneOncology Compliance Department on trends and issues identified in documentation, production coding or other areas.
• Collaborate with billing, coding, and clinical staff to address and resolve denials.
• Establish team benchmarks for productivity and perform staffing adjustment recommendations, as needed, due to growth or addition of providers.
• Monitor and strive to meet established KPI metrics. Report monthly benchmarks to leadership.
• Perform other duties as assigned to help drive our mission of improving the lives of everyone living with cancer.

Key Competencies:

• Positive and professional behavior in the workplace.
• Ability to monitor/access performance of self, other individuals, or organization to recommend improvement to workflow, processes, and procedures.
• Ability to build and maintain trusting relationships.
• Knowledge of clinic office procedures, medical practice and medical terminology including drug indications.
• Strong organizational skills and attention to detail.
• Excellent analytical, problem-solving, and communication skills.
• Ability to meet deadlines and work in a fast-paced, matrixed environment.
• Proficiency in the use of end-user computer applications regarding productivity (MS Word, Excel, Outlook, payer sites), database and patient scheduling and other medical information systems.

Qualifications:

• CPC, CCS-P or other coding certification required.
• Extensive knowledge of insurance payer guidelines and medical policies.
• Knowledge of ICD10, CPT and HCPCS codes required.
• Strong technical skills in Microsoft Office Suite (Word, Excel, PowerPoint).
• Bachelor’s degree or equivalent experience required.
• 3 years of experience in a community oncology setting preferred.
• 5 years of RCM healthcare experience required including coding and/or billing required.
• 3 years of supervisory experience preferred.

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