Director,HCC Coding & Compliance

The Director of HCC plans, organizes, directs, and controls the activities and staff required to provide chart review, data validation, medical record organizing, scanning and ensure timely provider feedback. This position is responsible for organizing, training, and directing the activity of the HCC department This position directly oversees HCC Coders and Auditors as well as oversight of chart review and special projects.

Essential Duties and Responsibilities include the following:

• Handle all provider issues and train providers.
• Train and oversee HCC Trainers.
• Special projects/audits as assigned by the CFO.
• Oversees compliance from the coders and provider feedback is submitted in a timely manner
• Maintain departmental communication and processes to increase coding and data validation standards.
• Assist in developing a workflow for coders/auditors.
• Perform random audits of coders, at all levels, to ensure the quality of the department.
• Manages NextGen coders and does the billing for all Lakeside Senior HMO encounters
• Reviews and gives feedback for RMG employed Physicians for the Senior HMO
• Participates in meetings to create, analyze, apply, interpret, and/or communicate policies, procedures, and regulations effectively.
• Supports company activities such as company goals/strategy and management meetings as required.
• Ensures the establishment and compliance of departmental goals and implementing procedures and performance standards to achieve these goals.
• Leads the HR activities for the staff to include making employment decisions, recommends promotions, writes and delivers employee performance evaluations on a timely basis, conducts training, provides motivation to staff, writes and delivers counseling and discipline to employees.
• Responsible for maintaining all timekeeping activities in ADP for all staff members.
• Prepare department reports as required.
• Recommend process improvements based on tracking and trending reports.
• Implement and coordinate issue resolution processes.
• Other duties as assigned by management.

Education and/or Experience:

• Associate degree or Bachelor’s Degree preferred.
• 5 years of medical group or health plan customer service experience is required.
• Knowledge of HMO, Knowledge of CPT, HCPCS, Hospital Revenue, and ICD-9 coding.
• Knowledge of HMO and CMS claims processing guidelines.
• Strong knowledge of Microsoft Windows environments such as Word and Excel.
• Self-starter, willing to take on multiple tasks.
• Strong analytical skills.
• Must be able to review and interpret health plan benefits and provider contracts.
• Strong communication skills
• Strong organizational skills with emphasis on prioritizing and attention to detail.

The pay range for this position atthe commencement of employment is expected to be between $140,000 annually to $200,000 annually; however, base pay offered may vary depending on multiple individualized factors, including market location, job-related knowledge, licensure, skills, and experience.

The total compensation package for this position may also include other elements, including a sign-on bonus and discretionary awards in addition to a full range of medical, financial, and/or other benefits (including 401(k) eligibility and various paid-time off benefits, such as vacation, sick time, and parental leave), dependent on the position offered.

Details of participation in these benefit plans will be provided if an employee receives an offer of employment.

If hired, the employee will be in an “at-will position” and the Company reserves the right to modify base salary (as well as any other discretionary payment or compensation program) at any time, including for reasons related to individual performance, Company or individual department/team performance, and market factors.

Regal Medical Group provides a comprehensive benefits package for full-time employees, emphasizing employee satisfaction and work-life balance. The package includes:

Health and Wellness

• Employer-paid comprehensive medical, pharmacy, and dental coverage
• Vision insurance
• Zero co-payments for employed physician office visits
• Flexible Spending Account (FSA)
• Employer-paid life insurance
• Employee Assistance Program (EAP)
• Behavioral health services

Savings and Retirement

• 401k Retirement Savings Plan
• Income Protection Insurance

Additional Benefits

• Vacation time
• Company celebrations
• Employee referral bonus
• Tuition reimbursement
• License renewal CEU cost reimbursement program
• Business-casual working environment
• Sick days
• Paid holidays
• Mileage reimbursement

Employers will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of the LA City Fair Chance Initiative for Hiring Ordinance.