Director, Coding Quality

1 month ago

Metro Manila, Philippines Tenet Global Business Center, Inc. Full time

JOB SUMMARY

The Director of GBC Coding Quality is responsible for the management of coding quality auditing and review services for Conifer’s Global Business Center. This position ensures coding and auditing teams uphold Conifer Quality & Performance standards and Conifer Compliance policies and procedures. The Director also monitors and contributes to the maintenance of department budget and financial guidelines.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Oversight for GBC Coding Quality teams and client SLAs around quality monitoring and reporting. Ensure Conifer Compliance and Quality & Performance policies and procedures are maintained and effectively carried out. Escalates coding quality issues to SR Director of CRI Quality and PerformanceContinually assesses and improves Auditor and Audit Team performance through daily interactions, analysis, education and implementation of sustainable performance improvement initiativesWorks collaboratively with CRI Operational leaders to ensure the coding quality of all coders meet or exceed quality standards, prepares necessary periodic reporting for Conifer and GBC leadership, clients and Conifer governing bodies; ensures compliance with approved coding guidance across coding and claims submission, and participates in annual risk assessmentsProvides input and maintains a standardized data quality management plan to ensure consistency of quality data for the organization’s internal data needServes as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes and demonstrates a thorough knowledge of coding guidelines, governmental regulations, and third party billing requirements and is able to compare/contrast the guidelines/rules/regulations in order to discern which apply to the audit being performed. Interprets the often complex clinical content of a patient record including the most complicated medical diagnoses and surgical procedures

KNOWLEDGE, SKILLS, ABILITIES 

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. 

Strong leadership and communication skills, problem solving abilities; good knowledge of coding and reimbursement systems Ability to build and maintain team cohesion, performance and talent retention § Serve as a resource to Conifer and client contactsAdvanced knowledge of ICD-10-CM/PCS CPT and HCPCS code sets, MS-DRG & APR-DRG classification and reimbursement structures, APC, OCE, NCCI, MUE classification.Advanced knowledge of disease pathophysiology, drug utilization and therapiesKnowledge of and revenue cycle structures of hospitals, physician offices, medical clinics, and third-party payorsKeeps abreast of new technology in coding and abstracting software and other forms of automation and stays informed about transaction code sets, HIPAA requirements and other future issues impacting the coding functionModerate to advanced skills in MS Excel and PowerpointAbility to work under deadlines and juggle multiple projects § Ability to work independently and as part of a teamAbility to multitask with flexibility of daily priorities 

EDUCATION / EXPERIENCE 

Include minimum education, technical training, and/or experience preferred to perform the job. 

Eight (8) years of relevant experience in coding or auditing in both facility-based and provider-based settings.Five (5) years of recent management experience related to coding quality and auditing functions.Documented coding and auditing experience. § Advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS classification systems, and CDI functions

CERTIFICATES, LICENSES, REGISTRATIONS

Degree: Healthcare/Clinical degree, MD, RN, Allied Health,Coder Certification such as CCS, CIC, CPCAHIMA ICD-10-CM/PCS Trainer preferred

 

 

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