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Coding Compliance Manager |
| Mount Sinai Medical Center, Manhattan, NY |
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(Full time) |
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Job Description:
Position Title: Coding Compliance Manager, Outpatient
Position Summary:
The Coding Compliance Manager has the responsibility for developing, implementing and maintaining a data quality compliance plan for outpatient coding and reimbursement. The Coding Compliance Manager will assist the Associate Director of Coding and Compliance with the development of policies and procedures. Responsible for the development of education and training programs regarding elements of the HIM Compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff, physicians, billing personnel and ancillary departments. Coordinates and conducts reviews of targeted cases to assure timely billing process and correct hospital reimbursement. In addition, will perform random audits to validate accuracy of APC and APG and coding assignments to ensure compliance with coding and billing requirements. Acts as a liaison between Health Information Management and Patient Financial Services to assure timely processing and claim accuracy. The Coding Compliance Manager works in conjunction with the Associate Director of Coding and the Outpatient Coding Coordinator.
Responsibilities and Duties:
1. Oversees and monitors implementation of the HIM compliance program.
2. Develops and coordinates educational and training programs regarding elements of the HIM compliance program, such as appropriate documentation and accurate coding, to all appropriate personnel, including HIM coding staff, physicians, billing personnel, and ancillary departments.
3. Maintains attendance rosters and documentation (agenda, handouts, etc.) for HIM training programs.
4. Conducts regular audits and coordinates ongoing monitoring of coding accuracy and documentation adequacy.
5. Provides feedback and focused educational programs on the results of auditing and monitoring activities to affected staff and physicians.
6. Reviews claim denials and rejections pertaining to coding and medical necessity issues and when necessary implements corrective action plan, such as educational programs, to prevent similar denials and rejections from recurring. Assists Finance Department with resolving insurance denials for outpatient claims related to coding issues.
7. Assures appropriate reimbursement for accounts with implants, high cost services and other items contractually approved for additional payments.
8. Conducts internal investigations of changes in coding practices or reports of other potential problems pertaining to coding.
9. Initiates corrective action to ensure resolution of problem areas identified during an internal investigation or auditing/monitoring activity.
10. Ensures the appropriate dissemination and communication of all regulation, policy, and guideline changes to affected personnel.
11. Acts as a resource for department managers, staff, physicians, and administration to obtain information or clarification on accurate and ethical coding and documentation standards, guidelines, and regulatory requirements.
12. Provides backup coding and managerial support to assure consistency and timeliness with revenue cycle process.
13. Computes, analyzes, presents reports generated from 3M report writer for internal use and improvement initiatives.
14. Investigates and acts to resolve outstanding accounts appearing on the discharged not final billed and Trac reports. Communicates issues to responsible individual and/or department for prompt resolution of unbilled accounts.
15. Maintains the confidentiality of information acquired pertaining to patient, physicians, associates, and visitors to the Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
16. Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of co-workers, and to report all preventable hazards and unsafe practices immediately to management.
17. Acts as a resource person for interdisciplinary team in order to promote collaboration and coordination of patient care, considering age specific, development, cultural and spiritual needs of the patient.
18. Assist in the review and distribution of coding related information to clinical staff, including CPT-4-CM and ICD-9-CM code changes, medical necessity policies and coding/billing information regarding new procedures and devices.
19. Responsible for remaining current with the latest healthcare technology and coding advise through reading available coding literature, attendance of seminars and in-services, internet research and other educational resources for outpatient reimbursement and coding.
20. Assists Associate Director with scheduling, planning and conducting outpatient coding in-services for staff members.
21. Participates in the Studer service excellence five pillar program focusing on excellence in service, quality, people, finance and growth.
22. Performs other duties as assigned.
Mount Sinai Medical Center is an equal opportunity/affirmative action employer. We recognize the power and importance of a diverse employee population and strongly encourage applicants with various experiences and backgrounds.
Mount Sinai Medical Center--An EEO/AA-D/V Employer.
HJ123
Job Qualifications:
Recruitment Requirements:
Registered Health Information Administrator or Registered Health Information Technician or equivalent experience preferred. Certified Coding Specialist Certification (CCS, CCS-P) or Certified Professional Coder (CPC) required. A strong background in ICD-9-CM Classification Systems. Anatomy, Physiology, Clinical Medical and Medical Terminology is required. Minimum of 3 years experience working in an acute care hospital. Must have excellent working and current knowledge of federal and the All-Payer DRG reimbursement methodology. Must be detail oriented with good verbal, written and computer communication skills, interpersonal and customer friendly skills, ability to operate PC based software and working knowledge of Microsoft Office Suite. Ability to work under pressure with time constraints. Must be able to understand and follow written and verbal instruction. The individual must have the ability to organize multiple priorities and make independent decisions. Must demonstrate initiative and ability to work with physicians and other healthcare providers. The team member has access to patient medical information, involved in ensuring the integrity of the legal medical record and must strictly uphold patient confidentiality.
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( AllHealthcareJobs Job ID:601915 last updated on 11/22/2009)
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