Position Summary: Manage the performance of a team of in-house and outsourced coding professionals who are responsible for Payment Integrity clinical and coding reviews. The incumbent ensures the effectiveness of the review process by identifying and implementing improvements to support measurable outcomes. The position works directly with other leaders throughout the MedReview organization to ensure the overall success of the clinical and coding review program. The position has a strong focus on operational effectiveness and efficiency.
Physical Requirements:

• Visual and auditory comprehension & function for written & verbal communication.
• Manual dexterity with ability to use computers and other office equipment necessary to perform assigned tasks.
• Ability to access various settings, negotiate architectural barriers (e.g. stairs) in office and community settings.

Remote Work Requirements:

• This is a remote position.
• Access to high-speed internet with secure Wi-Fi.
• A dedicated workspace with minimal interruptions to protect PHI and HIPAA information.
• Must be able to sit and use a computer keyboard for extended periods of time.

Requirements:

• Coding Certification required (at least one of the following is required and must be maintained as a condition of employment).
  • Registered Health Information Administrator (RHIA)
  • Registered Heath Information Technician (RHIT)
  • Certified Coding Specialist (CCS)
  • Certified Inpatient Coder (CIC)
  • Registered Nurse (RN) with at least one of the above coding certifications
• College level courses in medical terminology, anatomy, pathophysiology, pharmacology, and medical coding courses.
• 10 years of experience in MS-DRG and APR-DRG coding through acute care inpatient coding, auditing, and/or Payment Integrity DRG Validation.
• Management and leadership experience required.
• Adherence to the Official Coding and Reporting guidelines, AHA Coding Clinic determinations, and CMS and other regulatory compliance guidelines and mandates.
• Requires working knowledge of applicable industry-based standards.
• Proficiency in Outlook, Word, Excel, and other applications.
• Excellent written and verbal communication skills.
• Maintain professional credentialed status with approved continuing education programs.
• Ability to work independently and in a team setting.

Job Responsibilities: This list does not represent all responsibilities for this position. Candidates must understand and be willing and able to assume responsibilities other than these to meet the needs of the department and MedReview in general.

• Monitor day-to-day volume of work and ensure turnaround time expectations are met.
• Assists in the development, implementation, and management of organizational strategy, initiatives, KPIs, and/or budget and performance standards; communicates organizational objectives and goals.
• Trend and analyze productivity on a regular basis and provide direction as appropriate.
• Coach and develop team members (in-house and/or outsourced) for optimal performance and develop performance improvement action plans when appropriate.
• Ensure all production and quality standards including caseload, accuracy, review time, scheduling and capacity.
• Identify and implement process improvements, quality enhancements and cost control initiatives.
• Develop and implement policy and procedure recommendations to meet the needs of MedReview. 
• Monitor and approves scheduling of staff including vacation and sick time, etc.
• Liaise with internal leaders including physicians, nurses, technical and client partners.
• Assist in developing new clinical and coding review concepts.
• Manage vendor relationships.
• Act as an internal subject matter expert.
• Other duties as assigned.

Benefits: Medical, Dental, 401K match, 3 weeks’ vacation plus 11 holidays and more
Base salary
$160,000-180,000/Yr. plus performance bonus.
 

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