TMG Manager of Coding and Provider Documentation - TMG Billing (Days)

Statement Of Employment Philosophy

Being a part of Tanner Health System is more than a job, it is a promise we make to treat every patient with exceptional service every time they walk through our doors. Service excellence is the foundation of our organizational culture and the expectations we all set for each other, our patients, physicians and our community. All employees agree to abide by a set of service standards. These standards are the promise we make to provide the best care possible, and represent our beliefs, values and who we strive to become. We each commit to making Tanner Health System a great place for our employees to work, for patients to receive care and for physicians to practice medicine.

Functions

Area of Responsibilities

*Reviews and audits provider documentation and coding practices to identify areas for improvement. This includes providing feedback to providers on coding errors and offering recommendations for improvement.

*Works with providers to improve the quality, clarity, and completeness of clinical documentation to ensure accurate code assignment and optimal reimbursement. This includes promoting best practices in documentation that support accurate coding and billing.

*Conducts regular team meetings and provides ongoing education on coding updates and changes in regulations. This includes delivering coding education to healthcare providers, focusing on accurate coding, documentation improvement, and compliance. Conducts one-on-one training sessions, group workshops, and webinars as needed.

*Ensures compliance with federal, state, and local regulations, including HIPAA, CMS, OIG guidelines, and payer-specific requirements, including Medicare, Medicaid, and other third-party payer requirements.

*Manages comprehensive Tanner Medical Group Coding Audit program. Completes annual provider coding audits. Tracks and reports on the effectiveness of coding education programs, including improvements in coding accuracy and documentation quality.

*Collaborates with other departments, such as clinical, IT and finance, to ensure cohesive operations and address any billing and coding-related issues.

*Responsible for annual CPT, HCPCS, ICD-10 coding update reviews and implements Epic build edits to ensure continued compliance related to CMS updates.

*Supervises and mentors coding staff. Develops departmental goals, quality standards, and productivity benchmarks.

*Analyzes data to identify trends, revenue impact, and process improvement opportunities.

*Works with Tanner Medical Group primary care and specialty care clinics to improve revenue cycle processes within the practice and the centralized business office. This includes front desk functionality and charge entry functions located within a practice.

*Evaluates revenue cycle processes and works with practice leadership to implement needed changes to improve collection rates.

*Serves as the coding subject matter expert for coding staff, members of the management team, and other sections within the revenue cycle, as well as multiple areas outside the revenue cycle including Tanner Medical Group physician practices.

*Maintains knowledge of and complies with established policies and procedures including government, insurance, and third-party payer regulations.

*Demonstrates excellent customer service skills when resolving conflicts with staff and customers.

*Establishes productivity standards and performance assessments for the coding department and charge entry staff.

*Solves difficult payment and associated business office problems. Audits problem accounts.

*Develops and implements new procedures to improve the quality and quantity of work processed.

*Attends administrative meetings and participates in committees as requested. Conducts special projects and studies as directed.

*Participates in professional development activities and maintains professional affiliations.

*Maintains expert knowledge of coding workflow and optimizes use of available technology.

*Demonstrates expert job knowledge and applies current coding and billing regulations, policies, processes, and procedures with effective decision-making and problem-solving skills.

*Abstracts data in compliance with national, regional, and local policies, and interprets and reviews medical record documentation to assign accurate CPT-4 or ICD-10 diagnosis and procedure codes for outpatient cases.

Compliance Statement

Employee performs within the prescribed limits of Tanner Health System's Ethics and Compliance program. Is responsible to detect, observe, and report compliance variances to their immediate supervisor, the Compliance Officer, or the Hotline.

Required Knowledge & Skills

Education: Associate Degree or 2 years of college coursework

Experience: Five years of related experience. Requires broad knowledge of complex systems and procedures.

Licenses and Certifications

*CERTIFIED CODING SPECIALIST

Supervision

*Direct supervision of Tanner Medical Group coding and charge entry staff.

Qualifications

*Associate or bachelor's degree. RN preferred.

*Five years of relevant health care management experience with a minimum of one of the following credentials: CCS or CPC.

*Minimum of five years medical business office experience.

*Minimum two years relevant coding experience with CPT-4 and ICD-10 coding.

*Requires an excellent understanding of anatomy, physiology, medical terminology and disease processes.

*Experience with direct physician interaction required.

*Knowledge of and experience with Finance systems and applications required.

*Possesses PC skills, both keyboarding and applications

Definitions

The Manager holds a key leadership role in ensuring the accuracy, compliance, and efficiency of provider coding and documentation practices. This position is responsible for directing all aspects of provider coding operations and clinical documentation improvement initiatives to support accurate reimbursement and maintain data integrity across the organization. The Manager leads a team of certified coders and charge coordinators, partnering closely with providers, compliance, and revenue cycle teams to enhance documentation quality, strengthen coding accuracy, and drive continuous improvement in clinical and financial performance.

Position Responsibilities

Contact with Others: Frequent contacts of a significant nature involving difficult negotiations and technical matters requiring thorough knowledge of organization policies or treatment, plus an ability to understand, communicate with, and to lead, and influence others to obtain willing acceptance, consent, or action. Requires a high degree of diplomacy.

Effect of Error: Probable errors not easily detected and may adversely affect external as well as internal relationships and may result in major expenditures for equipment, materials, or procedures detrimental to the patient's welfare or the organization's interest. Work is subject to general review only and requires considerable accuracy and responsibility. Continually works with reports, records, plans, and programs of a major functional area of the organization where integrity is required to safeguard the organization's position. Duties may involve the preparation of data on which the administration bases important decisions and are highly confidential.

People Management Responsibilities

Supervisory Responsibility: Manages a small department (up to 15); has full responsibility for quality and quantity of work, costs, methods, and personnel; performs supervisory functions without intermediate supervisors. Manages a medium sized department of employees (15 to 40); has full responsibility for work, costs, methods, and personnel; usually has one or more intermediate supervisors.

Work Environment/Physical Effort

Mental Demands: Work involves a variety of complex problems to be solved under general organization policies. Ingenuity and judgment are required to review facts, plan work, estimate costs, and deal with factors not easily evaluated, interpret results, draw conclusions, and take or recommend action. Solutions to problems often require coordination with other departments.

Working Conditions: Minor - Occasionally involved in exposure to dirt, odors, noise, or some work is performed with exposure to temperature/weather extremes/occupational risk and probability of coming into contact with blood borne pathogens, other potentially infectious diseases, or biomedical/bio-hazardous materials.

Working Conditions Aspects for Immunizations

Performs tasks involving contact with blood, blood-contaminated body fluids, other body fluids, or sharps (needles): No

Directly works with Patients less than 12 months of age: No

Physical Effort: Light physical effort - Much of work done while sitting but with more than normal standing or walking. Handles light materials intermittently. Office or laboratory work requiring more than normal visual effort.

Physical Aspects

Bending: Occasional = 1% - 33% of the time

Typing: Frequent = 34% - 66% of the time

Manual Dexterity -- picking, pinching with fingers etc.: Not required

Feeling (Touch) -- determining temperature, texture, by touching: Not required

Hearing: Frequent = 34% - 66% of the time

Reaching -- above shoulder: Occasional = 1% - 33% of the time

Reaching -- below shoulder: Occasional = 1% - 33% of the time

Visual: Frequent = 34% - 66% of the time

Color Vision: Not required

Speaking: Frequent = 34% - 66% of the time

Standing: Occasional = 1% - 33% of the time

Balancing: Not required

Walking: Occasional = 1% - 33% of the time

Crawling: Not required

Running - in response to an emergency: Not required

Lifting up to 25 lbs.: Occasional = 1% - 33% of the time

Lifting 25 to 60 lbs.: Occasional = 1% - 33% of the time

Lifting over 60 lbs.: Not required

Handling -- seizing, holding, grasping: Occasional = 1% - 33% of the time

Carrying: Occasional = 1% - 33% of the time

Climbing: Not required

Kneeling: Occasional = 1% - 33% of the time

Squatting: Occasional = 1% - 33% of the time

Tasting: Not required

Smelling: Not required

Driving -- Utility vehicles such as golf carts, Gators, ATV, riding lawnmowers, skid steer, aerial lift: Not required

Driving -- Class C vehicles: Not required

Driving -- CDL class vehicles: Not required

N95 Respirator usage (PPE): Occasional = 1% - 33% of the time

Hazmat suit usage (PPE): Not required

Pushing/Pulling -- up to 25 lbs.: Occasional = 1% - 33% of the time

Pushing/Pulling -- 25 to 60 lbs.: Not required

Pushing/Pulling -- over 60 lbs. : Not required