Manager of RCO Coding & QA - Professional Outpatient/Hospital (Remote)

REQUIRED EDUCATION & EXPERIENCE:

Minimum Qualifications:

• Bachelor’s degree or equivalent.
• Three years of complex multi-specialty coding experience.
• Three years of previous management experience.

LICENSES, REGISTRATIONS OR CERTIFICATIONS:

Required: Must possess at least one of the following certifications or related certification as approved by department leadership:

• CCA – Certified Coding Associate (AHIMA)
• CCS – Certified Coding Specialist (AHIMA)
• CCS-P – Certified Coding Specialist – Physician-Based (AHIMA)
• RHIA – Registered Health Information Administrator (AHIMA)
• RHIT – Registered Health Information Technician (AHIMA)
• CIC – Certified Inpatient Coder (AAPC)
• COC – Certified Outpatient Coder (AAPC)
• CPC – Certified Professional Coder (AAPC)
• CPC-A – Certified Professional Coder – Apprentice (AAPC)
• CRC – Certified Risk Adjustment Coder (AAPC)
• CMC – Certified Medical Coder (Practice Management Institute)

Preferred: One or more of the following certifications:

• CIC – Certified Inpatient Coder (AAPC)
• COC – Certified Outpatient Coder (AAPC)
• CPC – Certified Professional Coder (AAPC)
• CPC-A – Certified Professional Coder – Apprentice (AAPC)
• CRC – Certified Risk Adjustment Coder (AAPC)
• CMC – Certified Medical Coder (Practice Management Institute).

JOB SUMMARY:

Develops, coordinates and manages all coding activities related to professional and outpatient hospital coding. The Manager of Coding ensures accurate and timely coding of all professional and outpatient hospital coding at UTMB. This position actively establishes policy and procedure both internally within the Revenue Cycle as well as throughout the institution to ensure compliance with all Federal and State-mandated billing and coding laws. The Manager of professional and outpatient hospital coding is responsible for managing critical key indicators and direct supervision of professional and outpatient hospital coders.

ESSENTIAL JOB FUNCTIONS:

• Under the direction of the Director of Coding, actively manages physician and Outpatient hospital coding operations for UTMB to promote compliance with Federal, state and professional requirements for physician and hospital documentation, coding and billing standards.
• Analyzes monthly key indicator data from the area of responsibility to identify areas of opportunity and impacting trends.
• Execute procedural process changes based on identified opportunities.
• Create, oversee and implement QA/coding team policies, processes, and procedures, to ensure timely and accurate processing of charges.
• Use creative thinking to solve problems and work through issues and recommend actionable solutions.
• Monitor key revenue cycle functions and staff productivity standards to ensure optimal departmental performance.
• Identifies process improvement opportunities for physician and outpatient hospital coding to achieve high quality outcomes in physician and hospital CPT, ICD-10, HCPCS coding, and documentation and billing.
• Oversee the management of QA/Coding Team personnel, working with Revenue Cycle leadership to review, monitor and improve the performance, productivity and accuracy of the professional and outpatient hospital coding team.
• Oversee coders, in all aspects of coding, Monitor and ensure compliance with governmental guidelines and QA/Coding Team billing processes.
• Oversee trending of denials and coding patterns to determine the need for education or process changes in order to maximize revenue.
• Maintain excellent relationships with, and serve as a liaison to department administration, physicians, clinic administration, HIM, RCO billing offices and other external customers.
• Maintain personal professional growth and development through seminars, workshops and professional affiliations. Establishes goals and objectives for employees to measure performance and cross training to mutually agreed-upon expectations and provides employees with access to resources needed in progressing in their development plans.
• Actively participates as coding, documentation and billing resource and consultant for physicians, mid-level providers, practice administrators and other staff. Works to resolve coding, documentation and billing issues timely and facilitates communication of coding related matters.
• Provides guidance and instruction in the interpretation of policies, procedures, and regulations.
• Monitors changes in Federal Regulations and advise departments of the impact of pending regulation changes. Establishes a policy to ensure compliance with all Federal MD regulations and insurance company requirements related to the revenue cycle for UTMB Hospitals and Clinics.

Marginal or Period Functions:

• Adheres to internal controls and reporting structure.
• Performs related duties as assigned.

KNOWLEDGE / SKILLS / ABILITIES:

• Knowledge of federal and state collection laws, Medicare, Medicaid, and other third-party pay or regulatory requirements.
• Thorough knowledge of physician reimbursement and managed care contract issues.
• Knowledge of Epic systems that support physicians billing services.
• General knowledge of medical terminology and trends related to disease processes and technology are available for detection and treatment.
• Strong communication and interpersonal skills with a high degree of professionalism in dealing with the staff at all levels of the institution.
• Excellent relationship-builder and communicator and extensive knowledge of health care operations and physician group practices.
• Effective problem-solving skills.
• Ability to develop, prioritize, and accomplish goals.
• Ability to analyze and evaluate data and make appropriate decisions/recommendations.
• Demonstrated project management and performance improvement skills.
• Strong analytical and reporting capabilities.
• Proficient in Excel, Access, Visio, pivot tables and report analyses.
• Must be effective in communicating down, horizontal and upward to the VP level regarding metrics, operations and projects representing the entire coding department not just the immediate areas of responsibility.

WORKING ENVIRONMENT/EQUIPMENT:

Standard office environment at UTMB’s main campus or other location. Occasional travel may be required. Standard office equipment.

SALARY RANGE:

Actual salary commensurate with experience.

WORK SCHEDULE:

Remote position, Monday through Friday, 8:00 AM to 5:00 PM, with occasional onsite meetings as required.

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.