Certified Coding Supervisor II

POSITION DESCRIPTION:

The Certified Coding Supervisor II is responsible for providing direct oversight of Certified Coding Specialists II. The team is responsible for facilitating proper medical coding for general and specialty surgery procedures, add-on codes and other services alike. Provides guidance and direction to ensure services rendered are coded and charged within expected timeframes. Ensures policies and procedures are followed and effectively and timely addresses barriers as they arise. This is accomplished through written and verbal communications, assisting with development of playbooks and ongoing monitoring of medical records, productivity and quality measurements by staff members. Emphasis is placed on adherence to Corporate Compliance Program, compliance with insurance carrier standards, optimizing revenues and the avoidance of monetary settlements from third party audits.

ESSENTIAL JOB FUNCTIONS:

1. Directs the work of assigned staff including the monitoring of staff competencies. Develops goals and objectives, conducts annual performance appraisals and the utilization of performance resolution process when needed.
2. Works closely with RSO coding auditor and reviews reoccurring audits to provide education to staff.
3. Manages more complex coding problems or issues.
4. Reviews unlisted codes to find comparable existing codes and works with compliance and the revenue applications team until code is priced and charged.
5. Responsible for researching and providing continuing education materials to coders.
6. Assists with medical record documentation audits as needed.
7. Assists the Certified Coding Manager with the recruitment, hiring, orientation, training and coaching of new team members in accordance with IHA guidelines. Effectively updates and organizes training materials for new employees.
8. Holds crucial conversations and leads team members based on their individual development levels.
9. Compiles, analyzes and presents data related to performance, compliant billing and documentation issues.
10. Coordinates team schedules to ensure adequate coverage exists to cover volume requirements. Maintains Time & Attendance program; coordinates timekeeping and time-off requests.
11. Encourages cooperation and the exchange of information between group members and/or groups in order to develop an effective, well-run team within a regional structure.
12. Communicates medical coding process improvements as appropriate/approved to the team and ensures implementation.
13. Identifies coding priorities and enhances workflow to minimize pre A/R and A/R days.
14. Identifies and reports any risk compliance areas in coding and documentation practices. Works collaboratively with the Compliance team to develop recommendations and effectively communicate solutions.
15. Serves as a single point of contact for coding and charge entry team across the region.
16. Communicates medical coding process improvements as appropriate/approved to the team and ensures implementation.
17. Identifies medical record documentation patterns/trends impacting coding and reimbursement and coordinates educational materials and communications.
18. Attends required internal and external meetings, performs other administrative support tasks, and assists in the development and oversight of the department budget.
19. Assists with special projects as needed.
20. Performs other duties as assigned.

ORGANIZATIONAL EXPECTATIONS:

1. Creates a positive, professional, service-oriented work environment for staff, patients and family members by supporting the IHA CARES mission and core values statement.
2. Must be able to work effectively as a member of the Revenue Operations team.
3. Successfully completes IHA's "The Customer" training and adheres to IHA's standard of promptly providing a high level of service and respect to internal or external customers.
4. Maintains knowledge of and complies with IHA standards, policies and procedures, including IHA's Employee Handbook.
5. Maintains complete knowledge of office services and in the use of all relevant office equipment, computer and manual systems.
6. Maintains strict patient and employee confidentiality in compliance with IHA and HIPAA guidelines.
7. Serves as a role model by demonstrating exceptional ability and willingness to take on new and additional responsibilities. Embraces new ideas and respects cultural differences.
8. Uses resources efficiently.
9. If applicable, responsible for ongoing professional development - maintains appropriate licensure/certification and continuing education credentials, participates in available learning opportunities.

MEASURED BY:

Performance that meets or exceeds IHA CARES Values expectation as outlined in IHA Performance Review document, relative to position.

ESSENTIAL QUALIFICATIONS:

EDUCATION: Associate's degree or equivalent combination of education and leadership experience.

CREDENTIALS/LICENSURE: Current AAPC certification as CPC or Current AHIMA certification as a CCS. Multiple advanced coding certifications through AAPC required.

MINIMUM EXPERIENCE: Five to seven years' recent coding experience in Healthcare. Previous 1-3 years' supervision/leadership experience required. Knowledge of ICD-10-CM and CPT-4 coding, reimbursement systems, medical terminology, anatomy and physiology/pharmacology, data collection techniques, and federal, state and payor-specific regulations pertaining to documentation and coding.

POSITION REQUIREMENTS (ABILITIES & SKILLS):

1. Knowledge of ICD-10-CM and CPT-4 coding, reimbursement systems, medical terminology, anatomy and physiology/pharmacology, data collection techniques, and federal, state and payor-specific regulations pertaining to documentation and coding.
2. Demonstrated ability to work independently and to effectively supervise and manage functional area within the team, supervise billing processes, support more complex issues, and provide feedback and guidance to staff.
3. Demonstrated ability to have crucial conversations and lead team members based on their individual development levels.
4. Abides by the Standards of Ethical Coding as set forth by AHIMA or AAPC and adheres to official coding guidelines.
5. Requires knowledge of physician group practice revenue cycle front-end functions to include patient registration, insurance verification, time of service payments, coding, charge entry, and provider payment enrollment.
6. Broad-based knowledge of healthcare insurance, patient billing and collection practices, and at-risk and capitated payments. Demonstrated competency in service excellence practices and Customer Resource Management (CRM).
7. Considerable knowledge and experience supporting and developing reporting and analytics for research, process improvement support and specific revenue management function. Ability to develop appropriate methods to collect, analyze and report data.
8. Strong analytical skills, change management and lean methodologies, and effective verbal, written and interpersonal communication skills.
9. Ability to develop workable implementation plans; communicate changes effectively; build commitment and overcome resistance. Ability to prepare and support those affected by change and monitor transition and evaluate results.
10. Inspires and motivates others to perform well; accepts feedback from others; gives appropriate recognition to others.
11. Proficient/knowledgeable in medical terminology related to job duties.
12. Ability to perform mathematical calculations needed during the course of performing basic job duties.
13. High level of proficiency in operating a standard desktop and Windows-based computer system, including but not limited to, electronic medical records, email, e-learning, intranet, Microsoft Word, Excel, database software and computer navigation. Ability to use other software as required while performing the essential functions of the job.
14. Excellent communication skills in both written and verbal forms, including proper phone etiquette and interpersonal skills. Ability to speak before groups of people, either in-person or virtual.
15. Ability to work effectively with various levels of organizational members and diverse populations including IHA staff, senior management, IGB Committees, providers, patients, family members, insurance carriers, vendors, external customers and community groups. Cultivates productive working relationships and maintains effective levels of communication between key stakeholders for all aspects of services provided.
16. Approaches conflict in a constructive manner. Helps to identify problems, offer solutions, and participate in their resolution.
17. Good organizational and time management skills to effectively juggle multiple priorities and time constraints.
18. Ability to exercise sound critical thinking, problem-solving and decision-making skills combined with strong analytical expertise.
19. Ability to handle patient and organizational information in a confidential manner.
20. Knowledge of the compliance aspects of clinical care and patient privacy and best practices in medical office operations.
21. Ability to travel to other office/practice sites and meeting and training locations.
22. Successful completion of IHA competency-based program within introductory and training period.

MINIMUM PHYSICAL EXPECTATIONS:

1. Physical activity that often requires keyboarding, phone work and charting.
2. Physical activity that often requires extensive time working on a computer.
3. Physical activity that sometimes requires walking, standing, bending, stooping, reaching, climbing, kneeling and/or twisting.
4. Physical activity that sometimes requires lifting, pushing and/or pulling up to 20 lbs.
5. Specific vision abilities required include close vision, depth perception, peripheral vision and the ability to adjust and focus.
6. Manual dexterity sufficient to operate a keyboard, photocopier, telephone, calculator and other office equipment.
7. Must hear and speak well enough to conduct business over the telephone or face to face for long periods of time in English.

MINIMUM ENVIRONMENTAL EXPECTATIONS:

This job operates in a typical office environment which involves frequent interruptions. This position requires significant interaction with people (many of whom are scared, hurt and/or ill) which can be stressful and result in competing priorities.