Job Description

Job Description

Job Description

Description:

Are you looking for a growing organization that is focused on setting new standards for excellence in pediatric care? Are you an experienced professional in coding and auditing? If the answer is yes, then we would love to hear from you!

The Senior Manager of Medical Coding and Chart Audits (SMMCA) focuses on coding, audit, and compliance. They are responsible for implementing coding initiatives to achieve outcomes associated with US Pediatric Partners strategic objectives, government and payer rules, and other applicable guidelines. The SMMCA will work with the Revenue Cycle and Compliance offices to implement enterprise-wide best coding practices. The SMMCA will work with the Business Development team on pre-acquisition diligence.

Key Responsibilities:

• Implement and monitor coding quality assurance programs, productivity, accuracy rates, and key performance indicators (KPIs) to identify areas for process improvement and efficiency.
• Conducts regular audits to ensure accuracy, proper documentation, and compliance with healthcare regulations.
• Provide technical expertise and recommendations to the Compliance team to resolve coding and chart documentation issues impacting accuracy and consistency of coded data.
• Support coding diligence process for practice acquisitions including chart audits and review of coding practices.
• Provides medical practice providers and staff with coding expertise, training and resources on coding procedures and workflows.
• Develop tools, or work within EMR capabilities, to improve documentation, reduce denial rates, ensure coding edits are current and compliant with applicable federal and state regulations, and CMS guidelines.
• Develop educational materials to support coding compliance and improvement efforts.
• Maintains and continuously improves knowledge base of coding documentation requirements, payer regulations, and ethical coding standards through review, study of resources and continuing education.

Minimum Qualifications:

• Education: A credentialed professional coder. Bachelor's Degree in a health care related field preferred.
• Experience: 5-7 years of professional coding and auditing. Some management experience. Pediatric experience preferred.
• Skills: Strong knowledge of billing, reimbursement, CPT-4 and ICD-10-CM coding; Demonstrates extensive knowledge of payer requirements, medical policies and compliance regulations. Experience working in multiple EHRs, especially EcW, Office Practicum and Allscripts
• Certification : CPC required. CPMA, CRC preferred.
• Job Skills : Strong written and verbal communication skills, including ability to effectively communicate with internal and external customers; strong analytical/critical thinking skills; detail oriented; proficiency with computers required. (MS Office-Word, Excel, and Outlook). Ability to work independently and conduct assignments to completion within parameters of instructions given and standard accepted practices.
• Preferred Attributes :
  • Collaborative, professional and proactive work style.
  • Ability to educate on best practices and influence change.
  • Establish strong relationships with stakeholders and colleagues.

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