Coding Audits & Education Supervisor

Silver Spring, MD, United States

Job Description - Coding Audits & Education Supervisor (24000054)

Job Description

Coding Audits & Education Supervisor - ( 24000054 )

Description

Description The Supervisor of Coding Audits and Education supports the supervision, management, evaluation, and improvement of operations related to coding education, audits, and denials. Leads the Coding and Auditing team responsible for evaluating the appropriateness and medical necessity of services and procedures billed based on supporting documentation, as well as the appropriateness of ICD-10, HCPCS and CPT codes and modifiers. Oversees the review of clinical denials for technical and professional services. Provides strategic direction for the development of training materials for coders, physicians, clinical documentation specialists, and other healthcare personnel. Partners with vendors for external audits of coder and organization performance.

Qualifications

Qualifications Minimum Education

Associate's Degree or equivalent coding audit and education work experience (Required)

Minimum Work Experience

4 years 4 years of hospital auditing and coding experience. Pediatric experience preferred.. (Required)

Required Skills/Knowledge

Strong understanding of coding processes and their relation to the overall Revenue Cycle data flow/third party reimbursement

Knowledge of accepted medical abbreviations and their meanings

Knowledge in the use of specialized references such as the ICD-10-CM/PCS and CPT-4 books, medical dictionaries and medical journals

Proficiency with Microsoft Office product suite

Ability to communicate professionally with physicians, third party payers and other organization members about to coding principles and processes

3M and/or Cerner Millennium experience strongly preferred

Required Licenses and Certifications

CPC, CPC-H, CCS-P , or CCS .

Functional Accountabilities

Audits and Coding

Oversee routine retrospective and prospective professional and technical billing audits, specialized and focused audits, and other audits as directed by the Senior Manager

Oversee preparation of written reports of audit findings and recommendations to leadership and staff as appropriate.

Assist in risk assessments to define audit priorities by evaluating previous audit findings, management priorities, ICD and CPT code utilization patterns, national normative data, CMS and Medicaid initiatives, and healthcare industry best practices.

Maintain up-to-date knowledge of healthcare coding compliance requirements, practices and trends and ensure teams’ compliance.

Maintain knowledge of current government and other third party payor coding and documentation requirements.

Oversee analysis of coding-related denials and lead efforts to resolve and learn from trends.

Assist in management of requests that come from Revenue Cycle teams related to coding questions on coding guidelines and denials, escalating as needed, and conducting appropriate research.

Analyze process improvement opportunities for auditing and coding teams to identify denial risks mid-cycle.

Education

Oversee professional and technical procedure and diagnosis coding education and training for coders, physicians, NPPs, clinical documentation specialists. and other healthcare personnel.

Oversee all activities related to the training programs, including curriculum development, job aids, testing methodology, software and delivery, exam development/delivery, employee competency metrics, certifications and development needs.

Assist in project management/leadership for all coding training programs as they are requested throughout the enterprise.

Determine Key Performance Indicators and create/analyze metrics to determine the impact of training initiatives and ensure goals are met.

Perform analysis of CNMC coding and productivity data against industry benchmarking standards as applicable.

Research coding guidelines when conflicts arise within current policies and procedures.

Research updated coding information as it becomes available annually and mid-year; summarize/share changes impacting Revenue Integrity staff members.

Communication

Role model expertise in communication through collaboration with the Director, Managers, physician and hospital management, and staff.

Work collaboratively with all Directors, Managers and Physicians to achieve optimal clinical code capture for appropriate SOI scores and DRG assignments.

Provide performance feedback in a constructive manner to staff.

Staff Development

Develop and implement systems to monitor performance and quality of audits and educational materials.

Develop and provide educational programs for auditors, denials analysts, and educators.

Coach, develop and encourage staff in designated areas of supervision.

Participate in human resource education programs including customer service, management and supervision and other industry-wide programs impacting health care.

Complete performance evaluations on all assigned staff in a timely manner.

Customer Service

Greet staff cordially and acknowledge positive productivity.

Actively participate in the resolution of challenges that impact negatively on the department.

Proactively demonstrate customer-oriented behavior and act as a role model for all staff.

Organizational Accountabilities

Organizational Accountabilities (Staff)

Organizational Commitment/Identification

Teamwork/Communication

Performance Improvement/Problem-solving

Cost Management/Financial Responsibility

Safety

Primary Location Primary Location : Maryland-Silver Spring

Work Locations Work Locations : Dorchester 12200 Plum Orchard Dr Silver Spring 20904

Job Job : Management

Organization Organization : Finance

Position Status : R (Regular) - FT - Full-Time

Shift : Day

Work Schedule : 8:30am - 5pm

Job Posting Job Posting : Jan 19, 2024, 11:29:46 AM

Childrens National Hospital is an equal opportunity employer that evaluates qualified applicants without regard to race, color, national origin, religion, sex, age, marital status, disability, veteran status, sexual orientation, gender, identity, or other characteristics protected by law.

Please note that it is the policy of Children's National Hospital to ensure a “drug-free” work environment: a workplace free from the illegal use, possession or distribution of controlled substances (as defined in the Controlled Substances Act), or the misuse of legal substances, by all staff (management, employees and contractors). Though recreational and medical marijuana are now legal in the District of Columbia, Children's National and its affiliates maintain the right, in accordance with our policy, to enforce a drug-free workplace, including prohibiting recreational or prescribed marijuana.

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