Job Summary:

• Carry out a thorough and consistent review of all coding staff
• Perform tasks by company-wide project-specific guidelines and standard coding practices acceptable in the industry
• Provide assistance in creating or/and reviewing medical coding related work flow and standard procedures
• Performs assessment of coding applications/tools and suggest the necessary input into them
• Work collaboratively with Billing team to ensure coding deliverables are achieved in a timely manner
• Communicate medical coding process improvements as appropriate/approved to the team and ensure implementation
• Provide assistance in creating, documenting, and maintaining medical coding related items, including Coding Guidelines and training materials
• Give presentations on medical coding issues to internal departments
• Collaborate with other departments and professionals within the organization to effectively resolve any medical coding issue that may arise
• Assist junior staff to develop competence in coding knowledge and skills by training, managing, and mentoring them
• Take part in company/project meetings
• Directly supervise the work/activities of staff of the coding department

Skills on Resume: 

• Coding Quality Assurance (Hard Skills)
• Standard Coding Practices (Hard Skills)
• Workflow Optimization (Hard Skills)
• Tool Assessment and Input (Hard Skills)
• Collaborative Teamwork (Soft Skills)
• Process Improvement Communication (Soft Skills)
• Training and Development (Soft Skills)
• Presentation and Supervision (Soft Skills)

Job Summary:

• Provide re-training or action plans to improve accuracy and production standards.
• Provides feedback and process improvement recommendations to appropriate health plan operations departments and participates in workgroups/committee meetings and process improvement solutions
• Advises Director of possible trends in inappropriate utilization (under and/or over) and other quality issues.
• Participates as requested in department meetings, client calls, and performance evaluation and management.
• Assigns float coding coverage for PTO, backlog, special projects, etc.
• Develop and implement organizational policies and procedures for the coding team. 
• Prepares RAPS submissions monthly for assigned clients.
• Maintain communication between the coding team by coordinating monthly coding team organizational meetings.
• Determines and monitors staffing matrix to assign workloads and optimize productivity and meet department standards.
• Responsible for reviewing and approving team member timesheets and PTO requests.

Skills on Resume: 

• Process Improvement (Hard Skills)
• Trend Analysis (Hard Skills)
• Meeting Facilitation (Soft Skills)
• Resource Management (Hard Skills)
• Policy Development (Hard Skills)
• Reporting and Submissions (Hard Skills)
• Team Communication (Soft Skills)
• Staff Management (Hard Skills)

Job Summary:

• Led the HCC coding team and reviewing procedures, HCPCS/ HCC and diagnosis coding for accuracy
• Provide education practice leadership to assist in the identification of clinical best practices to ensure diagnoses are captured in accordance with CMS Risk Adjustment coding guidelines.
• Partners payers and vendors to provide education and reporting to the HCC team.
• Manage provider coding accuracy audits in coordination with Clinical leadership to support provider performance tracking and incentive measures
• Coordinate with enterprise Compliance to establish RADV mock audit process and RADV Audit responses
• On-site review and analysis of provider HCC documentation with an eye toward compliance with CMS rules and regulations to capture risk adjusting (HCC) diagnoses
• Co-develop with HMG Clinical Leadership provider education curriculum to ensure ongoing best practices in documenting diagnoses to the highest level of specificity
• Develop customized education plans for assigned providers to address opportunities for clinical document improvements identified during the review
• Assist with the development, implementation, and oversight of team projects.
• Creation of job aids detailing coding rules and process for global teams
• Create and administer assessments to evaluate the comprehension of training efforts
• Ensure coder production is being met to satisfy client needs and contractual requirements; providing employees with QA and feedback

Skills on Resume: 

• HCC Coding and Compliance Expertise (Hard Skills)
• Education and Training Leadership (Soft Skills)
• Audit Management and Coordination (Hard Skills)
• RADV Audit Process Knowledge (Hard Skills)
• Documentation Analysis and Compliance (Hard Skills)
• Curriculum Development and Customization (Soft Skills)
• Project Management and Oversight (Hard Skills)
• Quality Assurance and Feedback (Soft Skills)

Job Summary:

• Existing service master review and maintenance including packages and file-related documentation.
• Assist in the submission and setup of new service codes for new service lines for GCOD.
• Coding training for existing and new physicians.
• Assist and guide the clinical team on proper coding, preparing coding error reports every month.
• Develop and establish a coding system and policies for the new clinic(s)/hospital(s).
• Assist with the recruitment and screening of new hires for home health and skilled nursing coding team
• Mentor, guide, and train team members including managing workload
• Monitor quality of coding and ensure performance expectations are conveyed and employees evaluated
• Interact with clients including managing and resolving client issues and ensuring monthly targets are met
• Formulate budget for coding division
• Coordinate workflow between coding, billing and accounting divisions

Skills on Resume: 

• Service Master Documentation Management (Hard Skills)
• Coding Systems and Policy Development (Hard Skills)
• Training and Development (Soft Skills)
• Coding Error Analysis and Reporting (Hard Skills)
• Recruitment and Team Management (Soft Skills)
• Client Interaction and Issue Resolution (Soft Skills)
• Budget Formulation and Financial Oversight (Hard Skills)
• Cross-Departmental Coordination (Soft Skills)

Job Summary:

• Oversees activities of the professional medical coders to ensure compliance with departmental policies, standards, procedures and applicable regulatory requirements.
• Teach, support, counsel, coach, evaluate and serve as a role model for all medical coders and assist staff to complete work and ensure all expected standards in the process are working optimally. 
• Troubleshoots and appropriately escalates issues to higher-level management (Director of Coding and Auditing) as necessary.
• Responsible for new client implementations and ensuring all workflow processes and business rules, with all nuances, are clearly captured and documented.
• Provides education and training to existing and new employee (coders) staff.
• Uses training in the anatomy and physiology of the human body and disease processes to understand the etiology, pathology, symptoms, signs, diagnostic studies, treatment modalities, and prognosis of diseases and procedures to be coded and to provide direction and mentoring of staff to ensure understanding of coding principles and correct coding initiatives.
• Performs clinical validation audits and interpretation of medical documentation to ensure capture of all relevant coding based on CMS Hierarchical Condition Categories (HCC) conditions that are applicable to Medicare Risk Adjustment reimbursement initiatives
• Provides clinical interpretation and guidance to clients.
• Collaboration with other Capstone teams to provide and quarterly education to clients.
• Oversees quality audits to assure consistency, accuracy and standardization of procedures and optimize medical coding. 

Skills on Resume: 

• Leadership and Team Management (Soft Skills)
• Training and Development (Soft Skills)
• Regulatory Compliance (Hard Skills)
• Clinical Validation and Auditing (Hard Skills)
• Process Improvement (Soft Skills)
• Client Implementation and Documentation (Hard Skills)
• Collaboration and Communication (Soft Skills)
• Quality Assurance (Hard Skills)

Job Summary:

• Ensures timely and accurate collection of patient information for appropriate reimbursement, case mix index, DRG assignment, research, and education meeting health system goals.
• Assesses current HIM coding compliance activities (POA, PACT, etc.) identifying areas of high risk and evaluating risk factors in coding, documentation practices and patient safety and assists with Fiscal Intermediary, RAC activities and other Perspective Payment retrospective reviews.
• Reports and maintains a formalized review process for outcome monitoring, coding compliance, and appropriate reimbursement and enforces policies and procedures pertaining to remote coders.
• Ensures compliance with Medical Necessity of NCD and LCD guidelines for appropriate reimbursement monitoring failed accounts
• Reporting outcome of opportunities for improvement as well as compliance with APC and ASC grouping guidelines and modifier requirements for appropriate reimbursement.
• Assists in the selection and testing of software application upgrades, equipment, services, and supplies necessary for efficient and cost-effective operation of the department.
• Selects, develops, counsels, evaluates, and rewards personnel to assure high level of quality, productivity, efficiency and job satisfaction in accordance to client’s policies, procedures, and service standards.
• Communicates timely and effectively with the Director, Department Management staff, employees, Medical staff, and Ancillary departments.
• Reviews claim denials and rejections pertaining to coding identifying opportunities and developing action plan for the prevention of similar denials and rejections from recurring.
• Assists with the development and implementation of standardized coding guidelines and documentation requirements by CMS and OIG guidelines and educates and prepares in-services providing decision support overviews, demonstrations, and/or presentations for consistency and proper application of coding rules and regulations.
• Monitors coding staff assignment and scheduling to provide efficient workflow and coverage of A/R functions as well as optimal utilization of available human resources and 
• Ensures accurate and timely completion of inpatient, outpatient surgery, and outpatient coding to meet accounts receivable goals to facilitate timely billing.
• Demonstrate leader competencies while meeting client expectations

Skills on Resume: 

• Coding Compliance and Risk Assessment (Hard Skills)
• Policy Enforcement and Outcome Monitoring (Hard Skills)
• Regulatory Compliance (Hard Skills)
• Software and Equipment Selection (Hard Skills)
• Personnel Management (Soft Skills)
• Effective Communication (Soft Skills)
• Claims Denial Management (Hard Skills)
• Coding Guidelines and Education (Hard Skills)