• Provides daily supervision to the coding staff.
• Manages unbilled accounts for all patient types the Coding Department is responsible for coding.
• Maintains a working knowledge and serves as a resource for the types of coding performed in the Coding Department including ICD-10-CM and HCPCS.
• maintains a working knowledge and serves as a resource of coding guidelines and principles, governmental regulations, protocols and third-party requirements regarding coding and documentation.
• Provides coding in-services tailored to address identified opportunities to improve coding practices.
• May serve as a liaison and resource in the clinical documentation program, 3M Service Line Solution, between the inpatient coders and Documentation Specialists.
• Communicates to the medical staff coding issues and DRG/APC changes.
• Performs/Assists in internal audits to ensure coding accuracy and quality is met by the coders.
• Keeps current with the latest coding changes and developments and keeps the Health Information Administrator informed.
• Codes inpatient, outpatient and/or physician services dependent upon the types of coding performed in the Coding Department.
• Reconciles denied claims due to coding. 
• Communicate such denials to the responsible coder and educate the coder on proper coding and billing issues.

Skills: Supervisory Skills, Coding Expertise, Regulatory Knowledge, Training and Development, Clinical Documentation Liaison, Communication Skills, Audit and Quality Assurance, Claims Reconciliation and Education

• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Establishes professional and positive work environments by modeling respect and dignity toward all employees and acknowledging the value of individual’s effort and contributions.
• Provides feedback to supervisor to develop efficiencies.
• Works with the coding team to analyze needs, and provides training along with resources.
• Provides oversight to team leads and coder/documentation reviewers.
• Orients new employees and contracted coding/documentation reviewers to role and expectations.
• Assists with facilitating access and training on client's individual electronic medical records, specific workflow and HHCodePro.
• Proactively identifies coder/documentation reviewer concerns and requests assistance up-line
• Coordinates with education and quality department
• Participates in strategy sessions, and manages communication and information flow between team members.
• Coordinates outsourcing partnership with Project Manager.
• Assists in the continual education of new and current outsourced coder/documentation reviewers.
• Collaborates with line management to ensure contractual obligations with partner agencies/projects are fulfilled.
• Acts as a customer liaison with accounts, builds relationships with key personnel at the agency and looks for opportunities to sell additional billable services.

Skills: Team Leadership and Oversight, Training and Development, Feedback and Process Improvement, Coordination and Communication, Customer Relationship Management, Problem-Solving and Issue Resolution, Outsourcing and Contract Management, Proactive and Strategic Participation

• Proactively identifies and leads agency concerns and requests assistance up-line along with consulting with the education and quality department.
• Participates in the implementation process of a new agency.
• Develops individualized agency processes for coding and/or documentation review in a client's electronic medical record system in collaboration with the Team Lead.
• Conduct reviews of coding, OASIS and Plan of Care while providing recommendations following OASIS guidance, CMS rules/regulations and coding guidelines.
• Provide written and verbal feedback related to documentation and coding.
• Develop and maintain knowledge of EMR systems utilized by various agencies.
• Provides coverage for Sr. Coding Manager and Team Leads absence.
• Communicate concerns and trends to the Supervisor.
• Identifies and communicates to his/her supervisor, ideas and possible solutions to improve processes/procedures.
• Understands coding services objectives and how each client conforms to them while following through to ensure objectives are met
• Analyzing company data to assist in delivering optimal management and decision-making
• Investigates company data to find patterns and trends. 
• Acts on patterns and trends in a timely manner.

Skills: Agency Concern Management, Implementation Expertise, Process Development, Coding and Documentation Review, Feedback Provision, EMR Systems Knowledge, Coverage and Support, Data Analysis and Process Improvement

• Manage and direct activities related to Coding & Reimbursement functions and employees
• Oversees surgical specialty, ASC, office based and primary care coding teams.
• Manages the Coding Helpline team and the Shared Services Trainer.
• Implements and monitors quality assurance efforts and maintains coding accuracy metrics.
• Monitor key revenue cycle functions and staff productivity standards to ensure optimal departmental performance.
• Mentors and develops staff and contributes to department meetings and coding newsletter.
• Serves as an expert resource to physicians, nursing, technical, and interdisciplinary staff.
• Leads or participates in cross-functional workgroups/committees
• Assists with the development, implementation, and adherence to policies and procedures.
• Review medical documentation to verify accurate and complete assignment of CPT/HCPCS and ICD codes following policies and procedures established by DMG.
• Proactively and reactively research, analyze, and resolve coding and reimbursement issues within clinical, billing, and operations departments.
• Develops reports and presentations on projects for Senior Management.
• Ensure the DMG fee schedule(s) is maintained consistent with established methodology to ensure optimal reimbursement and appropriate pricing for services.

Skills: Coding Team Leadership, Quality Assurance and Metrics Management, Revenue Cycle Management, Staff Development and Mentorship, Cross-Functional Collaboration, Policy and Procedure Implementation, Coding and Reimbursement Issue Resolution, Reporting and Presentation Skills

• Assists with edit and Claims Manager rule building and maintenance.
• Keep abreast of current changes in coding and reimbursement requirements for government programs and other third-party payers and assist in implementing and communicating the changes to physicians and staff.
• Conduct system testing, provide feedback, and support conversions/implementations.
• Collaborate with various project teams and departments to ensure optimal performance of revenue cycle processes.
• Assist the Business Office staff with pay or denials, government requests, and patient inquiries related to coding or billing issues, and makes decisions on whether to appeal claims for payment.
• Actively participates in meetings and/or seminars and disseminates the information to peers and staff to enhance the knowledge and skills of the organization.
• Demonstrates the ability to educate/train others and assists with various departmental training initiatives. 
• Training environments may include, but are not limited to, new employee orientation, coding classes/programs, training and support for new practice conversions, Epicare implementation and continuing education.
• Assist with interviewing potential candidates for hire
• Develop an internal training program for new employees
• Process payroll and resolve any payroll issues
• Perform yearly performance reviews on employees
• Approve time off requests for employees

Skills: Coding and Reimbursement Knowledge, System Testing and Implementation, Revenue Cycle Management, Training and Education, Project Collaboration, Claims Management, Performance Management, Internal Training Program Development

• Supervises including hiring, training, developing, motivating and disciplining the staff in the Clinical Audit area consisting of Clinical Auditors, Medical Abstractors and Audit Clerks.
• Establishes and updates all Audit Policies and Procedures. 
• Develops audit methodology when appropriate. 
• Remains current in coding and/or documentation requirements. 
• Suggests coding process improvements for optimal coding reimbursement.
• Acts a liaison between third party auditors and Tufts MC. 
• Ensures all audit timelines are met. 
• Ensures documentation is complete and available at the time of review.
• Coordinates all hospital charge-based audits.
• Ensures Clinical Auditors who respond to the audits provide feedback to ancillary areas regarding poor billing or documentation practices if identified.

Skills: Staff Supervision and Development, Audit Policies and Procedures Management, Audit Methodology Development, Coding and Documentation Compliance, Liaison and Communication, Timely Audit Completion, Hospital Charge-Based Audit Coordination, Feedback and Process Improvement

• Assess training needs of Tufts MC physicians and administrative managers on proper documentation and billing practices to maximize revenues. 
• Prevents educational seminars for large groups of clinical staff.
• Coordinates response to all Medicare Part B (outpatient) audits. 
• Communicate any changes or problems to the Administrative Manager and Patient Accounts. 
• Identifies trends in denials and communicates any changes in audit focus to applicable departments.
• Ensures all inpatient denials are responded to in a timely manner and coordinated with Quality Support Services.
• Works closely with Quality Support Services concerning any potential denial. 
• Provides timely response to any requests for clinical information.
• Ensures all Clinical Audit employees conduct themselves in a way that is courteous, helpful, and professional. 
• Ensures that the department’s customer service standards are maintained at all times.

Skills: Training and Development, Audit Coordination, Regulatory Compliance, Communication, Quality Assurance, Customer Service, Trend Analysis, Clinical Documentation

• Experience coding pathology and ophthalmology
• Experience managing a team
• Professional fee coding certification (CPC or CCS-P or similar)
• Experience working in an enterprise-level environment
• Extensive experience working as a certified coding expert within health insurance claims processing, and system configuration environment
• Extensive experience in how codes relate to plan building, provider data maintenance and reimbursement methodologies including fee schedules, contract management and workflow processes.
• Experience required in providing coding expertise to support a team processing HMO, Managed Care and Medicaid claims.
• Excellent interpersonal, oral, and written communication skills
• Strong attention to detail and organization
• Ability to work independently, strong analytic skills (using SSRS or SQL)
• Advanced skill level in Microsoft Office Suite (Excel, Word, PowerPoint)
• Advanced problem-solving, critical thinking, and process analysis skills

Qualifications: BA in Computer Science with 4 years of Experience

• Understanding of the healthcare industry, including competitors, the regulatory environment, and industry trends
• Experience with Big Data solutions such as EMR, Hadoop, Presto, Spark, and Ranger
• Experience programming with general-purpose languages such as Java, Python, or Go and scripting languages such as Unix Shell, Bash, and PowerShell
• Experience with AWS
• Experience with Git, CI/CD tools, and automation practices
• Experience with enterprise logging, monitoring, and alerting solutions such as Splunk, New Relic, and PagerDuty
• Familiar with Kafka, Containers, Terraform, Ranger, and NiFi
• Experience with Medicare and Medicaid billing and coding regulations.
• Proficiency in ICD-10 CM must be demonstrated and measured by required testing and/or certification.
• Knowledge of Medicare and Medicaid professional doc requirements, CMS coding guidelines, Teaching Physician doc requirements, and NCCI/ OCE edits.
• Knowledge of ICD-9, ICD-10CM, and CPT coding skills.
• Good interpersonal and verbal/ written communication skills. (English Language).

Qualifications: BS in Information Technology with 5 years of Experience

• Experience in ensuring complete, accurate, timely and consistent coding and DRG/code validation while adhering to published coding guidelines and Company/HSC policy.
• Experience Review and manage data outcomes to identify root causes of coding quality issues for overall coding quality improvement.
• Work in partnership across various teams to communicate production coding-related issues such as workflow processes, forecasting, scheduling, quality activities, etc.
• Experience in coaching and helping develop team members
• Experience helping resolve dysfunctional behavior within functional area(s), discipline and counsel staff as necessary.
• Experience in managing and monitoring coding and clinical documentation improvement reconciliation operations.
• Responsible for ensuring employee work schedules sufficiently meet those requirements as established by the HSC Leadership team and through executed SLAs.
• Experience in maintaining up-to-date knowledge of regulatory changes affecting coding requirements and ensuring staff are appropriately educated.
• Experience with Healthcare management/leadership 
• Experience with inpatient/outpatient hospital coding  (production, auditing, and or managing)
• Experience Certification - RHIA, RHIT, and/or CCS

Qualifications: BA in Software Engineering with 4 years of Experience

• Ability to perform the duties of the position preferred may be substituted for the degree preference.
• Must have current coding certification from American Academy of Professional Coders or American Health Information Management Association.
• Knowledge of CFR 42 part 2, HIPAA and HITECH
• Must maintain strict confidentiality in compliance with HIPAA and HITECH Act standards.
• Advanced knowledge of medical terminology, anatomy, Coding Guidelines, ICD-10CM, CPT-4, and HCPCS coding.
• Knowledge of current and developing issues and trends in medical coding procedure requirements.
• Knowledge of auditing concepts and principles.
• Knowledge of patient care charts and documentation standards.
• Strong verbal, written, analytical, and interpersonal skills.
• Demonstrated ability to prioritize tasks and work independently.

Qualifications: BS in Health Information Management with 5 years of Experience

• Experience in coding i.e., acute care facility coding (inpatient and/or outpatient), physician practice coding, billing and/or reimbursement. 
• Strong computer skills with advanced systems knowledge
• Knowledge of ICD-9/10 and CPT/HCPCS coding principles and guidelines.
• Knowledgeable in current governmental/regulatory requirements (state, federal, JCAHO, HIPAA, etc.) and provisions that apply to healthcare institutions. 
• Maintains knowledge of applicable coding documentation and billing regulations related to Medicare, Medicaid and commercial insurance. 
• Analytical ability to gather and interpret data to identify discrepancies, problems or issues, to determine compliance with regulations, policies and procedures. 
• Leadership skills such as accountability, decision-making, coaching and counseling. 
• Excellent communication, organizational, and customer relation skills used in frequent public interaction. 
• Strong Coding background, DRG auditing, training, policy and procedure, and data quality management skills.

Qualifications: BA in Computer Information Systems with 6 years of Experience

• Knowledge of completion of a Medical Terminology, Anatomy and Physiology, and Pharmacology course.
• Experience in coding/HIM certification required (e.g. RHIA, RHIT, CCS, CPC).
• Experience in coding/abstracting and inpatient and outpatient coding.
• Experience with 3M, AS400, Cerner Soarian/OneChart a plus.
• Computer and software skills, including Word, Excel, PowerPoint, and encoder/grouper.
• Strong written and verbal communication skills.
• Leadership, organizational skills.
• Ability to work under pressure, detail-oriented, and fast learner.
• Working knowledge of hospital HIS system.
• Knowledge of medical terminology and ICD/CPT coding system.
• Basic knowledge of medical insurance practice.

Qualifications: BS in Data Science with 5 years of Experience

• Knowledge of credentials to include one or a combination of the following RHIA, RHIT CCS and/or CPC.
• Experience in risk adjustment coding and supervising risk adjustment staff and programs.
• Experience in auditing of clinical data in physician offices or medical facilities
• Knowledge of health care insurance claims practice and compliance.
• Extensive knowledge of Medicare and CMS Risk Adjustment payment rules, regulations and guidelines as they relates to managed care organizations
• Knowledge of CPT, ICD-9, ICD-10, DRG, APC/ASC, HEDIS, AAPCC, Medicare services and reimbursement methodologies, revenue codes and RBRVS.
• Knowledge of risk adjustment categories and hierarchy.
• Experience with EPIC EMR
• Knowledge of Certified Risk Adjustment Coder (CRC) or Certified Professional Coder (CPC).

Qualifications: BA in Healthcare Administration with 4 years of Experience