Major Responsibilities:

Oversees the development and implementation of prospective and retrospective review plans to sample employed clinicians’ medical record documentation and comparison to services selected for billing. Develops focused medical record reviews, formal reviews, and supervises subsequent reviews associated with Internal Audit reviews and Compliance reviews.Determines best-practice methodologies to review findings with Clinician Support, clinic operations leaders, and physicians to provide feedback on proper coding and documentation practices. Oversees the organization and prioritization of schedules for team assignments of documentation and coding accuracy as well as new provider initial reviews per plan.Determines format and deadlines for providing feedback to clinicians or the Compliance department. Ensures that all required reviews are conducted timely for the established plan and summary reports are generated for coding leadership and the Compliance Committee. Develops mechanism to identify specific quality issues for each clinician to allow for focusing of follow-up reviews to identify improvement or correction of those elements for which the clinician has received education. Ensures compliance with the coding quality plan and issues escalation process for any clinician who is not successful in meeting the minimum acceptable thresholds.Provides feedback to coding leadership when issues are identified that need improvement by coders. Overseas the scheduling and monitoring of ad hoc focused reviews requested by the compliance department, clinic administration, and coding leadership. Promotes effective professional relationships with coding liaisons and clinicians to facilitate problem-solving, as appropriate. Provides information to the coding education team for the development of teaching materials for clinicians and coders. Identifies evaluates and acts to resolve any barriers to meeting documentation standards.Utilizes monitoring tools to track and report the progress of the physician documentation and coding accuracy plan. Collaborates and communicates with individual clinicians and other leaders in patient care, revenue cycle services, information technology, physician compensation, and ancillary areas to implement and monitor clinician documentation quality.Develops, maintains, and oversees the formal quality program for all certified coders. Overseas a relational database for production coders’ quality reviews. Create updated assessments to test skills based on assigned work. Organizers, coordinates, prioritizes and maintains schedules for team assignments of coding quality reviews responsible for these statistical analyses of quality data for the coding department with the intent to understand quality trends for each coder, sub-team, supervisor team, production team, and the overall department.Provides accurate and thorough monthly statistical reports to support progress made in the area of coding quality. Creates, monitors, and communicates coding team member quality and trends summarizing the teams and overall department quality. Create and maintain coding quality monitoring tools for use by the coding quality specialists, coding leads, and other coding leaders as needed. Uses the result of coding quality trends to develop further coding educational resources.Collaborates and communicates with other leaders to implement and monitor coding quality. Communicate with coding department leaders regularly regarding department quality review results and trends as well as feedback from team members’ quality reviews.  Collaborates with the coding education team to identify educational needs for coders based on the results of their quality reviews. Maintains up-to-date knowledge of Medicare, Medicaid, and other regulatory requirements about nationally accepted coding policies and standards.Performs human resources responsibilities for staff which includes coaching on performance, completing performance reviews, and overall staff morale. Recommends hiring compensation changes, promotions, corrective action decisions, and terminations.Responsible for understanding and adhering to the organization's Code of Ethical Conduct and for ensuring that personal actions and the actions of employees supervised, comply with the policies, regulations, and laws applicable to the organization's business.

Licensure, Registration, and/or Certification Required:

Coding Associate (CCA) certification issued by the American Health Information Management Association (AHIMA), orCoding Specialist - Physician (CCS-P) certification issued by the American Health Information Management Association (AHIMA), orHealth Information Administrator (RHIA) registration issued by the American Health Information Management Association (AHIMA), orHealth Information Technician (RHIT) registration issued by the American Health Information Management Association (AHIMA), orProfessional Coder (CPC) certification issued by the American Academy of Professional Coders (AAPC), orSpecialty Coding Professional (SCP) certification issued by the Board of Medical Specialty Coding and Compliance (BMSC), andSpecialty Medical Coding Certification issued by the American Academy of Professional Coders (AAPC).

Education Required:

Associate degree (or equivalent knowledge) in Health Information Management or related field.

Experience Required:

Typically requires 3 years of experience in advanced professional coding, physician billing processes, and workflow and reimbursement in a large, complex clinic or hospital setting. Experience at a lead or senior level is required.  

Knowledge, Skills & Abilities Required:

Demonstrated leadership skills and abilities including team building, conflict resolution, project management, and effective decision making.Exceptional knowledge of ICD-10-CM, CPT, and HCPCS coding guidelines. Advanced knowledge of medical terminology, Anatomy, and Physiology.Expert knowledge of Medicare, Medicaid, and commercial payor coding guidelines.Advanced computer skills including the use of Microsoft Office, email, and exposure or experience with electronic coding systems or applications.Advanced organization prioritization and reading comprehension skills.            Advanced analytical skills with high attention to detail.Advance knowledge of care delivery documentation systems and related medical record documents.Advanced interpersonal communication skills necessary to collaborate with physicians, other clinicians, and professional coding department team members and leadership.Ability to work independently and exercise independent judgment and decision-making.Ability to meet deadlines while working in a fast-paced environment.Ability to take initiative and work collaboratively with others.

This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties