The Coding Resources Manager will serve as the focal point for coding and coding compliance related activities. Responsible for the development, implementation and management of the coding compliance programs for all areas of the organization (i.e., nursing home, patient accounts billing functions, acute care hospital, and physician clinic). Position will be responsible for establishing and assessing coding and compliance standards in conjunction with organizational policies/procedures, regulatory requirements and state and federal requirements/standards. Prepares and communicates findings, conclusions and recommendations, collaborates with all levels of the leadership team to address deficiencies and provide education as needed. Accountabilities include quality of services; short and long-range planning to achieve goals; fiscal control; physician and departmental relations; personnel management; compliance as related to coding and billing functions; coding of professional and facilities services.
Essential Job Functions
• Interprets supports and models behaviors consistent with the mission and philosophy of Billings Clinic and department/service.
• Develops, implements, monitors and revises coding compliance requirements as it relates to all areas of the organization to include requirements for nursing home, patient accounts billing functions, acute care hospital, and physician clinic. Responsibilities include review of all government and third party bulletins to evaluate changes and to coordinate and communicate with the impacted areas to ensure changes are made to comply with the new requirements. Coordinates closely with all levels of the leadership team.
• Develops and implements audit criteria to measure coding compliance with policies, procedures and governmental/payer regulations and to detect any potential violations. Develops an audit schedule and work plan. Ensures that the audit schedule is maintained and that recommendations and deficiencies identified in the audit are implemented and resolved. In coordination with legal counsel, reports self-discovered violations of program requirements.
• Develops and maintains policies and procedures that promote Billings Clinic’s commitment to coding/billing compliance and to address high-risk areas. Develops, implements and maintains written facility-specific coding guidelines for both hospital and clinic coding which address specific coding issues and meet regulated coding practices.
• Develops and implements reporting and tracking systems to document coding compliance efforts and progress made in establishing methods and/or processes to improve the efficiency and quality of services and/or to prevent or reduce the organization’s vulnerability to illegal, unethical or improper conduct, fraud, abuse and waste. Develops and maintains all Medical Records coding compliance related files, reports and databases.
• Monitors education and training for all coding staff to ensure staff understand and comply with pertinent federal, state and regulatory requirements and standards for coding and compliance.
• Participates as part of the corporate compliance leadership team. Provides direction and advice for medical staff and other employees for coding and/or compliance related matters. Participates in Institutional and Reimbursement Compliance Committees as active member. Reports coding and/or compliance activities to these Committees as appropriate.
• Prepares and develops annual budget for Coding Resources coding and compliance related expenses; maintains budget variances within acceptable standards. Develops and makes recommendations for both short and long term planning for coding and compliance related matters.
• Maintains standards for AR and coding turnaround to support timely billing and financial responsibility. Assures accuracy and quality through regular quality review of all coding staff.
• Monitors and evaluates Case Mix Index. Directs activities of Nurse Reimbursement Specialist to achieve optimum reimbursement based upon documentation. In coordination with Nurse Reimbursement Specialist works with Medical Staff to achieve accurate documentation for services provided, guidelines for coding complications, and education programs related to coding and documentation requirements.
• Identifies needs and sets goals for own growth and development; meets all mandatory organizational and departmental requirements.
• Maintains competency in all organizational, departmental and outside agency environmental, employee or patient safety standards relevant to job performance.
• Performs other duties as assigned or needed to meet the needs of the department/organization.
Minimum Qualifications
Education
• 4 year Bachelor's degree in Health Information Management, Healthcare Administration, or other applicable field
Experience
• 2 years of physician and/or hospital coding
• 3 years of health care related management experience
Certifications and Licenses
• Current Montana state license as applicable
Or an equivalent combination of education and experience relating to the above tasks, knowledge, skills and abilities will be considered. Employees that require a licensed or certification must be properly licensed/certified and the licensure/certification must be in good standing.
