Manager, Hospital Coding Assurance

Job not on LinkedIn

October 14

🎸 Tennessee – Remote

Although this job is listed in Tennessee, this company may be open to hiring remote in other states.

🤠 Texas – Remote

Although this job is listed in Texas, this company may be open to hiring remote in other states.

+1 more states

🎸 Tennessee – Remote 🤠 Texas – Remote ⚔️ Virginia – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👔 Manager

Apply Now

Receive Emails with Similar Jobs

Wellstar Health System

WebsiteLinkedInAll Job Openings

Healthcare Insurance

Wellstar Health System is a comprehensive healthcare organization dedicated to providing personalized and compassionate care to patients in Georgia and South Carolina. With a diverse range of career opportunities, Wellstar supports its employees' career growth and wellbeing through a positive culture, excellent benefits, and a focus on diversity, equity, and inclusion. The organization emphasizes the importance of treating both patients and staff with respect and care, making it a sought-after workplace in the healthcare industry. Wellstar is committed to offering high-quality healthcare services and maintaining strong community engagement.

10,000+ employees

Founded 1992

⚕️ Healthcare Insurance

📋 Description

• Manage Hospital Coding Assurance Audit Process - Implement and maintain audit controls and measurements for internal processes. • Develop management reports showing the results of the audit process. Works with the Director of Hospital Coding Assurance, Coding leadership, and other departmental leads as appropriate in developing action plans and follow-up initiatives to address the opportunities identified through the annual audit process. • Develop training and educational material associated with identified risk or audit findings. • Assist Director in providing oversight and leadership surrounding external audits. • Ensure correct processes are in place for accurate, complete and compliant coding/billing across hospital billing to include but not limited to the following: - Billing for items or services not rendered or not provided as claimed - Submitting claims that are not reasonable and necessary - Billing for non-covered services as if covered - Identification of risk areas involving Inpatient Admission criteria - Unbundling - Failure to properly use modifiers - Submitting claims with diagnoses / procedures not documented in the medical recordUpcoding / overcoding / undercoding - Failure to apply correct coding practices for Inpatient populations • Manages communication from the Hospital Coding Assurance Team to Compliance and Coding leadership: - Chart documentation deficiencies and opportunities for improvement that may result in over coding and/or under coding - Trends in RAC or other governmental audit findings - Federal and state regulations governing billing (medical necessity, Inpatient Admission Criteria, etc) - National/Local Coverage Determination and Official Coding Guideline reviews appropriate for the procedure /test in question - Trends in denials - Results of benchmark comparisons such as PEPPER reports. - Claim issues involving hospital services (may need to incorporate other departments such as: PFS, Revenue Management, and other hospital departments as needed). • Assists the Coding Assurance Director in developing, coordinating, and management of Annual Audit plan - Reviews OIG annual workplan - Identifies areas of focus related to WellStar services - Works with management teams in focus areas to complete risk assessment - Consolidates findings and creates recommendations for presentation to executive leadership team - Conducting investigations surrounding reports of coding/billing violations or other compliance related issues. • Assist with the development of corrective action plans. - Ensure the appropriate disclosures are completed and submitted. • Communication of new/revised regulations/requirements - Provide support and guidance regarding implementation of new regulations as related to site dpts - Provide support and guidance regarding action plans for deficiencies - Provide regular updates to Administrator, Directors, medical staff, and managers regarding regulatory requirements and continuous monitoring. • Maintains active issues log to ensure timely response, resolution, and follow-up. • Requests and collects data on population for sampling - Analyzes data and selects sample - Utilizes Microsoft Access and Excel to collect/analyze/report findings/trends - Creates executive summary with findings and recommendations. References governmental regulations where needed. • Conducts exit conference with staff, physician, and executive leadership team when appropriate - Works with external agencies to coordinate/review documentation supporting services provided and billed - Prepares disclosure documentation as needed - Manages organizational structure supporting review functions - Performs complex data analytics. • Provides Education - Provides post review follow-up education with WellStar employees, management and physicians - Provides education on new releases from Medicare and Medicaid - Answers compliance/documentation/coding/billing questions via e-mail - Maintains education log - Provides 3rd-party software training, support, and guidance for team member audit functions. • Coordinates Internal Process for Medicare Recovery Audit Contractor (RAC) and other Governmental Focused Reviews - Facilitates the Recovery Audit Contractor software implementation and response team. - Develops workflows, policies and procedures, and the communication plans to prepare and manage the RAC requests and denials. - Monitors overall effect of RAC on the WellStar facilities and reports results of requests, denials, appeals, risks, and opportunities on a regular basis to leadership. - Develops action plans and coordinates multidisciplinary teams for performance improvement. - Assumes a leadership role with the interdisciplinary teams to achieve optimal outcomes (includes RAC Task Force). - Analyzes RAC data to determine trends in documentation, coding, billing to improve organizational practices, policies and procedures, and to maintain integrity and compliance with all federal programs.

🎯 Requirements

• Bachelor's Degree in Health Information Management, Business Required or other health care Required or business-related field • Minimum 5 years of inpatient auditing, and/or other related coding/billing/compliance related experience Required and Outpatient coding experience Preferred • Extensive knowledge of medical terminology, CPT-4 procedural coding (including Level II HCPCS), ICD-9-CM coding, ICD-10-CM, ICD-10-PCS and all coding and billing guidelines. • Hospital billing experience with focus on government payors. • Extensive experience with medical record chart review and/or extraction for hospital billing. • Extensive experience with Medicare, Medicaid, and reimbursement rules and regulations. • Experience with management information systems and medical software. • Competent in Microsoft Word and Excel software in a Windows environment (Experience with Microsoft Access Is a plus).

🏖️ Benefits

• 10K Sign On Bonus Available!