Coding Quality Director

6 hours ago


Manila, National Capital Region, Philippines Tenet Global Business Center, Inc. Full time

Director of GBC Coding Quality job at Conifer involves leading coding quality auditing and review services, ensuring compliance with quality and performance standards, and contributing to department budget and financial guidelines.

Key Responsibilities:

  • Oversight of GBC Coding Quality teams and client Service Level Agreements (SLAs) around quality monitoring and reporting.
  • Continual assessment and improvement of auditor and audit team performance through daily interactions, analysis, education, and implementation of sustainable performance improvement initiatives.
  • Collaboration with CRI Operational leaders to ensure coding quality meets or exceeds quality standards, prepares periodic reporting, ensures compliance with approved coding guidance, and participates in annual risk assessments.
  • Input and maintenance of a standardized data quality management plan to ensure consistency of quality data for the organization's internal data needs.
  • Serving as a subject matter expert and resource for information and clarification on accurate and ethical coding and auditing processes, demonstrating a thorough knowledge of coding guidelines, governmental regulations, and third-party billing requirements.

Requirements:

  • Strong leadership and communication skills, problem-solving abilities, and good knowledge of coding and reimbursement systems.
  • Ability to build and maintain team cohesion, performance, and talent retention, serving as a resource to Conifer and client contacts.
  • Advanced knowledge of ICD-10-CM/PCS, CPT, HCPCS code sets, MS-DRG & APR-DRG classification, and reimbursement structures, APC, OCE, NCCI, MUE classification.
  • Advanced knowledge of disease pathophysiology, drug utilization, and therapies.
  • Knowledge of revenue cycle structures of hospitals, physician offices, medical clinics, and third-party payors.
  • Moderate to advanced skills in MS Excel and PowerPoint.
  • Ability to work under deadlines, juggle multiple projects, and work independently and as part of a team.
  • 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, and documented coding and auditing experience.
  • Coder Certification such as CCS, CIC, CPC, and AHIMA ICD-10-CM/PCS Trainer preferred.


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