JOB SUMMARY:

Develops, coordinates and manages all coding activities related to clinical coding. The Manager of Coding ensures accurate and timely coding of hospital coding at UTMB. This position actively establishes policy and procedure both internally within the Revenue Cycle as well as throughout the institution to ensure compliance with all Federal and State-mandated billing and coding laws. The Manager of Clinical Coding is responsible for managing critical key indicators and direct supervision of hospital coders.

 

REQUIRED EDUCATION / EXPERIENCE:

·         Bachelor’s degree or equivalent.

·         Minimum of one certification from AHIMA or AAPC –required (RHIT, RHIA, CCS, CPC-H).

 

·         Three years of complex DRG and ICD10 coding experience, and three years of previous management experience. Strong analytical and reporting capabilities. Proficient in Excel, Access, Visio, pivot tables and report analyses. Must be effective in communicating down, horizontal and upward to the VP level regarding metrics, operations and projects representing the entire coding department not just the immediate areas of responsibility.

 

ESSENTIAL JOB FUNCTIONS:

• Under the direction of the Director of Coding, actively manages Clinical coding operations for UTMB to promote compliance with Federal, state and hospital documentation, coding and billing standards.

• Analyzes monthly DRG key indicators data from the area of responsibility to identify areas of opportunity and impacting trends.

• Execute procedural process changes based on identified opportunities.

• Create, oversee and implement QA/coding team policies, processes, and procedures, to ensure timely and accurate processing of charges.

• Use creative thinking to solve problems and work through issues and recommend actionable solutions.

• Work closely with CDI to monitor key metrics and educational opportunities to ensure optimal coder / CDI performance.

• Identifies process improvement opportunities for clinical coding to achieve high quality outcomes in hospital DRG, ICD10- PCS, CPT, ICD-10, HCPCS coding, documentation and billing.

• Oversee the management of QA/Coding Team personnel, working with Revenue Cycle leadership to review, monitor and improve the performance, productivity and accuracy of the professional and outpatient hospital coding team.

• Oversee clinical coders, in all aspects of coding, . Monitor and ensure compliance with governmental guidelines and QA/Coding Team billing processes.

• Oversee trending of denials and coding patterns to determine the need for education or process changes.

• Maintain excellent relationships with, and serve as a liaison to department administration, physicians, CDI, HIM, RCO billing offices and other external customers.

• Maintain personal professional growth and development through seminars, workshops and professional affiliations. Establishes goals and objective for employees to measure performance and cross training to mutually agreed-upon expectations and provides employees access to resources needed in progressing in their development plans.

• Actively participates as coding, documentation and billing resource and consultant for physicians, mid-level providers, practice administrators and other staff. Works to resolve coding, documentation and billing issues timely and facilitates communication of coding related matters.

• Provides guidance and instruction in the interpretation of policies, procedures, and regulations.

• Monitors changes in Federal Regulations and advises departments of the impact of pending regulation changes. Establishes a policy to ensure compliance with all Federal MD regulations and insurance company requirements related to the revenue cycle for UTMB Hospitals and Clinics.

• Adheres to internal controls and reporting structure.

 

MARGINAL OR PERIODIC FUNCTIONS:

• Other duties as assigned.

 

KNOWLEDGE / SKILLS / ABILITIES:

• Knowledge of federal and state collection laws, Medicare, Medicaid, and other third-party pay or regulatory requirements.

• Thorough knowledge of physician reimbursement and managed care contract issues.

• Knowledge of Epic systems that support physicians billing services.

• General knowledge of medical terminology and trends related to disease processes and technology available for detection and treatment.

• Strong communication and interpersonal skills with a high degree of professionalism in dealing with the staff at all levels of the institution.

• Excellent relationship-builder and communicator and extensive knowledge of health care operations and physician group practices.

• Effective problem-solving skills.

• Ability to develop, prioritize, and accomplish goals.

• Ability to analyze and evaluate data and make appropriate decisions/recommendations.

• Demonstrated project management and performance improvement skills.

 

Salary Range

Actual salary commensurate with experience.

 

 

Equal Employment Opportunity

UTMB Health strives to provide equal opportunity employment without regard to race, color, religion, age, national origin, sex, gender, sexual orientation, gender identity/expression, genetic information, disability, veteran status, or any other basis protected by institutional policy or by federal, state or local laws unless such distinction is required by law. As a Federal Contractor, UTMB Health takes affirmative action to hire and advance protected veterans and individuals with disabilities.

Compensation