Coding and Auditing Manager - Physician Enterprise

Job Summary

The Coding and Auditing Manager - Physician Enterprise performs audits and review of clinical documentation, provider and support staff billing records, administrative data, and coding records, with responsibility for rendering appropriate, well supportive, and thoroughly- documented decisions which may result in the identification of improper payments (overpayments and underpayments) on claims paid to various providers of clinical services. Ongoing training and education are provided to the audit processes, industry changes, and other topics as needed. In addition to coding and reimbursement expertise, this position requires a self- motivates, organized, detail- oriented person, with superior critical thinking and communication skills.

Required Education and Experience

• Minimum of five years' experience outpatient coding and/ or peer- review auditing is highly desired as is experience with Clinical Documentation Improvement Initiatives, and familiarity with Charge Master.

Required Minimum Knowledge, Skills, Abilities and Training

• Critical thinking and problem solving skills Knowledge of ICD-10 and CPT/HCPCS coding and reimbursement.
• Previous experience training and mentoring junior- level coders and or peer- review auditing is highly desired.
• Experience with clinical documentation, improvement initiatives, and familiarity with Charge Master. Understands Medicare, Medicaid, and commercial provider reimbursement methodologies, and possess strong data analysis skills.
• A solid working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, PowerPoint, and Excel) and windows operating systems is required in order to manage applications.
• Traveling for additional training and on- site reviews on an as needed basis.

Essential Key Job Responsibilities

• Provide leadership to coding and auditing staff in addition to process oversight and compliance
• Reviews medical records to identify recovery opportunities on claims for Outpatient, Professional, and Allied Services.
• Provides a detailed rationale for every medical record review resulting in a findings report, including supporting references.
• Correctly interprets and utilizes reference materials, including coding standards and guidelines including but not limited to NCDs, LCDs and client payment policies.
• Provides ongoing input to the Management team on claims selection criteria and education process.
• Ability to work with a mentor various disciplines (RN, coders, and support staff) in coding/auditing concepts related to specific specialty areas.
• Interacts with Providers and other personnel in a professional manner.
• Communicates timely with management regarding illnesses, appointments, vacation requests, changes in work schedule, performance barriers, and computer issues.
• Complies with department standards regarding productivity and audit quality.
• Performs other duties as assigned.