Department: Coding Postualte
Reports To: Director of Coding and Coding Compliance
FLSA Status: Exempt
Revision Date: August 2016
This individual is responsible for maintaining departmental day-to-day activities, monitoring and prioritizing workflow and schedules. Directing, managing, and overseeing the coding for both facility and physician claims for In-House and BPO Coders. Review medical records to ensure proper coding of condition and treatment, using ICD-10, CPT, HCPCS and other standard classification coding system. This role will require experience with coding and compliance in the emergency room setting.
Essential Duties & Responsibilities
• Supervises and perform a wide range of activities pertaining to the review and coding of ER & outpatient medical records information.
• Establishes, implements and maintains a formalized review process for coding compliance, including a formal review (Audit) process; designs and uses audit tools to monitor the accuracy of clinical coding.
• Reviews and interprets operational data to assess need for the procedural revisions and enhancements; participates in the design and implementation of specific systems to enhance revenue and operating efficiency.
• Participates in the development and implementation of operating policies and procedures.
• Keep up to date with coding, code changes and distribute the information within the coding department.
• Recruits, and hires personnel for the department.
• Sets up schedule and resources for orientation and staff development.
• Monitors employee progress during orientation for achievement of competencies and goals.
• Measures and documents employee performance on a daily basis and reviews overall performance monthly.
• Provides reports on performance indicators on a monthly and quarterly basis to staff and management.
• Monitors employee performance for staff development, recognition, and goal achievement.
• Monitors the coding and compliance for both facility and physician claims.
• Implement and oversee ICD-10 coding.
• Ensures that all charges are coded within 48 hours.
• Ensures employees work assigned reports (missing charges, diagnosis needed, etc.) on a daily basis.
• Coordinates processes and productivity with the billing/collections director.
• Identifies, prioritizes and implements improved processes to increase efficiency and effectiveness of the department.
• Collaborates with other departments on identified quality initiatives.
• Maintains communication among the physicians, insurance companies, and other departments.
• Maintains patient and company confidentiality.
• Develops and revises department’s policy and procedures as needed.
• Completes annual employee reviews, including 45-day and 90-day orientation interim evaluations.
• Participates in continuing educational programs pertaining to the department expertise.
• Reviews and revises the Operations Manual related to coding and compliance.
• Completes all other duties as assigned by director
• Demonstrate knowledge of and adhere to regulations and Emergency Center policies and procedures pertaining to safety, emergency preparedness, infection control, OSHA, fire safety and hazardous materials
• Participate in performance improvement activities as necessary
• Maintain confidentiality of patient related issues and adhering to all HIPAA rules and regulations.
• Demonstrate effective interpersonal skills
• Treat all patients, visitors, and staff members fairly and with respect
• Utilize effective communication methods and skills
• Explain all procedures, treatments, and care while remaining aware of language barriers
• Able to perform care in non-judgmental manner and recognize discrepancies between patient and personal beliefs
Emergency Center Policy
• Ensure personal appearance is business casual and professional at all times
• Responsible for wearing Emergency Center identification badge at all times which must be visible and above the waistline
• Attend all Emergency Center required meetings and in-service education
• Remain flexible in staffing patterns and resolution of staffing conflicts; participates in temporary assignments
• Compliance with attendance standards
• Demonstrate flexibility when changes in assignments are necessary
EDUCATION & EXPERIENCE
• High school diploma or equivalent
• Certified Coding
• Minimum 5 years’ experience in coding
• College experience or degree preferred
• Minimum 2 years management experience with coding and compliance
• Excellent communication skills
• Working knowledge of managed care.
• Ability to perform multiple tasks simultaneously.
• Excellent customer service skills
• Ability to read and comprehend simple instructions, short correspondence, and memos. Ability to write simple correspondence. Ability to effectively present information in one-on-one and small group situations to customers, clients, and other employees of the organization
• Ability to add and subtract two digit numbers and to multiply and divide with 10’s and 100’s. Ability to perform these operations using units of American money and weight measurement, volume, and distance
• Ability to apply common sense understanding to carry out instructions furnished in written, oral, or diagram form. Ability to deal with problems involving several concrete variables in standardized situations
• Computer experience, Excel and Word strongly preferred.
• Certified Professional Coder
• Professional Maturity: The ability to separate emotional feelings from the real issues at hand
• Responsibility: The ability to accept choices you have made and the results they have led to
• Communication: The ability to write and speak effectively; actively listens to others, and give feedback
• Flexibility: Demonstrate responsiveness and adaptability following change initiatives
• Intelligence: Understand information and apply new knowledge
• Energetic: Exhibits high levels of energy and enthusiasm
• Organized: Efficient in structuring tasks to be accomplished
• Computer Savvy: The ability to use technology efficiently and effectively
• Customer Service: The ability to enhance customer satisfaction
• Job Knowledge/Technical Knowledge: Knowledgeable of current role and technical systems, and the impact it has on the organization
• Integrity and Respect: Demonstrates upmost level of integrity
• Interpersonal Communication: Writes and speaks effectively based on the psychological, relational, situation, environmental and cultural dynamics within the situation
• Collaboration and Partnership: Encourages participation from team members
• Manages Change: Demonstrates flexibility with changing environments
• Problem Solving: Resolve issues in a timely manner
• Attention to Detail: Follows procedures to ensure entry of data
• Organization: Uses time efficiently by prioritizing and planning work activities
• Judgment: Ability to make independent decisions
• Teamwork: Works with others to accomplish objectives and shows support for decisions
• Quality: Sets high standards to ensure quality in work performed
• Accountability: Takes responsibility for adhering to all company policies, procures, and performance expectations
• The physical demands for this position include: adequate vision, hearing, and repetitive motion
• Light physical activity performing non-strenuous daily activities of an administrative nature
• Ascending or descending stairs, ramps and the like, using feet and legs and/or hands and arms
• Substantial movements (motion) of the wrist, hands, and/or fingers in a repetitive manner
• Bending legs downward and forward by bending leg and spine
• Well-lighted, heated and/or air-conditioned indoor office setting with adequate ventilation