Hypertension Program Manager and Coding Admin

POSITION SUMMARY

Plans, organizes, and manages the system-wide Professional Coding and Clinical Documentation Integrity functions for General Internal Medicine. Acts as a liaison and subject matter expert for General Internal Medicine hospital and medical staff inpatient and outpatient procedural diagnosis coding and clinical documentation integrity.

ESSENTIAL JOB FUNCTIONS AND ACCOUNTABILITIES

• Review quality of code selection in the electronic medical records to support compliant professional coding and billing.
• Provide feedback and education when upcoding or under-coding issues are identified.
• Meet with providers to provide feedback and education regarding proper coding, documentation, and any areas for improvement.
• Manages the reviews for quality and accuracy of documentation for all Department of Medicine providers.
• Evaluate clinical documentation to identify any issues, inconsistencies, or areas of improvement and conduct root cause analysis if needed.
• Engages with Revenue Cycle team in coding education, feedback, collaboration, and resolutions of any issues.
• Monitors open encounters to encourage timely and accurate coding and documentation.
• Analyzing billing and clinical data to track hypertension management trends and identify improvement areas.
• Ensuring accurate coding of hypertension and related conditions for proper reimbursement and data tracking.
• Developing patient financial education programs to enhance compliance and reduce financial barriers.
• Collaborating with clinical and administrative staff to streamline processes, improve care coordination, and track progress toward quality improvement goals.
• Contributes to financial planning, resource management, and process improvement.
• Serves as liaison with managed care organization representatives.
• Data Analysis and Insights:
  • Analyze billing data to identify trends and patterns in hypertension management.
  • Utilize Epic Dashboard reports to track hypertension prevalence, blood pressure control rates, and demographic patterns.
• Compliance and Accuracy:
  • Ensure hypertension and comorbid conditions are accurately coded, using ICD-10 codes to the highest level of specificity.
  • Monitor adherence to CPT coding guidelines and identify opportunities for provider education on documentation improvements.
• Financial Planning:
  • Manage project budgets to ensure effective allocation of resources for impactful interventions.
  • Collaborate with care coordinators and pharmacists to provide patients with medication price lists and financial assistance options.
• Process Improvement:
  • Streamline billing processes to minimize administrative burden while improving reimbursement efficiency.
  • Identify inefficiencies in billing and data tracking systems and recommend solutions.
• Patient Education:
  • Implement programs to educate patients about hypertension management costs and financial resources.
  • Improve compliance by increasing patient awareness of financial responsibilities and options.
• Collaboration and Communication:
  • Partner with Hypertension Clinic Manager & DOM Care Manager, social workers, and clinical teams to align billing practices with overall project goals.
  • Report financial performance and quality improvement outcomes to stakeholders.
  • Collaborate with Managed Care Organization representatives to determine best practices for QI implementation and how MCOs can contribute to improvement in quality outcomes in the outpatient clinic setting.
• Technology Integration:
  • Assist with EHR system optimization for better tracking and data integration.
  • Collaborate with the Department of Medicine’s data analyst to develop tailored reports for data collection and monitoring.

REQUIRED QUALIFICATIONS

• Education: High School Diploma/GED
• License and/or Certification:
  • One of the following credentials:
    • CCS (Certified Coding Specialist)
    • CDIP (Certified Documentation Improvement Practitioner)
    • CCDS (Certified Clinical Documentation and Certification)
    • CPC (Certified Professional Coder)
    • CPC – H (Certified Professional Coder - Hospital)
    • CCS-P (Certified Coding Specialist – Physician)
    • RHIT (Registered Health Information Technician)
    • CCA (Certified Coding Associate)
• Years of Experience:
  • 10 years of experience working with inpatient and outpatient coding and/or clinical documentation integrity for General Internal Medicine within an academic institution

PREFERRED QUALIFICATIONS

• Education: Bachelor’s Degree

WORKING CONDITIONS

• Primarily working inside in a well-lit, well-ventilated area

The above list of duties is intended to describe the general nature and level of work performed by people assigned to this classification. It is not intended to be construed as an exhaustive list of duties performed by the people so classified, nor is it intended to limit or modify the right of any supervisor to assign, direct and control the work of employees under his/her supervision.

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex, pregnancy, sexual orientation, gender identity or gender expression, age, disability, military or veteran status, height, weight, familial or marital status, or genetics.

Equal Opportunity Employer/Drug-Free Workplace