Associate Manager, Inpatient/Outpatient Coding Review

🕒 vor 9 Tagen

🤠 Texas – Remote

🤠 Texas – Remote

💵 $85.000 - $109.200 / Jahr

⏰ Vollzeit

🟢 Junior

🟡 Mittelstufe

👔 Manager

🦅 H1B-Visum-Sponsor

Dieses Unternehmen hat in der Vergangenheit H1B-Visa gesponsert.

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Gainwell Technologies

WebsiteLinkedInAlle Stellen

10.000+ Mitarbeiter

💼 Beratung

📦 Logistik

⚕️ Krankenversicherung

💰 Grant im 2023-06

Consulting • Logistics • Healthcare Insurance

Gainwell Technologies ist der führende Anbieter von digitalen und cloud-fähigen Lösungen im Bereich der Human Services und der öffentlichen Gesundheit in den USA. Mit einem zielorientierten Ansatz bedient Gainwell Kunden in allen 50 US-Bundesstaaten und konzentriert sich darauf, Gesundheitsergebnisse zu verbessern und intuitive, menschzentrierte Erfahrungen zu bieten. Ihr umfassendes Lösungsspektrum umfasst die Modernisierung von Medicaid Enterprise, Datenanalysen, Anbieter-Dienstleistungen und Apothekenlösungen, die alle darauf ausgelegt sind, die Zukunft des Gesundheitswesens voranzutreiben und das Wohl der Gemeinschaft zu verbessern.

Beschreibung

• Supervise the quality review program, creating policies and processes relating to quality and ensuring continuous conformance with appropriate standards, regulations, and contractual agreements. • Develop, implement, and maintain quality assurance processes and performance benchmarks for DRG validation, inpatient coding, and outpatient coding/billing audits. • Supervise and mentor clinical auditors and coding specialists; provide education, coaching, and performance feedback. • Monitor and report key performance indicators (KPIs) for audit accuracy, productivity, and interrater reliability. • Identify trends, root causes, and opportunities for improvement in documentation or coding accuracy. • Analyze audit results, denial trends, and payer findings to identify systemic issues and recommend corrective actions. • Prepare and present regular reports and dashboards for leadership, highlighting performance metrics, audit outcomes, and improvement initiatives. • Support compliance and revenue integrity efforts by ensuring the accuracy of coded data used for reimbursement, quality reporting, and analytics. • Develop and deliver training programs for coding, clinical, and quality assurance teams. • Stay current with evolving CMS regulations, ICD-10-CM/PCS updates, and industry standards for inpatient coding and DRG assignment. • Drive continuous quality improvement initiatives to enhance effectiveness and efficiency. • Serve as a Subject Matter Expert to assess new tools, automation, product development, and clinical readiness; act as a resource for resolving escalated issues, and coach and mentor staff to develop a high-performing team. • Manage and evaluate individual and team performance, and take appropriate action to meet and/or exceed performance standards. • Perform other functions as assigned.

🎯 Anforderungen

• At least one of the following active Coding Certifications is required and is to be maintained as a condition of employment: RHIA, RHIT, CCS, CIC, CCDS or CPC • 5+ years inpatient or outpatient coding/auditing required • Working knowledge of ICD-10 CM, ICD-10-PCS, APC, ASC, HCPCS, CPT coding and DRG reimbursement methodologies strongly preferred • Bachelor’s degree in business, healthcare administration, or related field preferred • 2+ year’s management or supervisory experience preferred

🏖️ Vorteile

• generous, flexible vacation policy • a 401(k) employer match • comprehensive health benefits • educational assistance • various leadership and technical development academies