Coding Manager

Responsible for developing, implementing, and maintaining risk adjustment functions and processes for the client, leading a team of coding auditors, and facilitating the improvement in overall quality, compliance, completeness, appropriateness, and accuracy of documentation and coding for professional services. While reporting to the client's Finance Director, will work collaboratively with operations and clinical leadership to improve coding and documentation performance.

List of job requirements:

1. Responsible for developing, implementing, and maintaining risk adjustment functions and processes for the client to facilitate improvement in overall quality, completeness, appropriateness, and specificity of documentation.

2. Hire, lead, train, and oversee a successful team of coding auditors and manage their performance to create a cohesive and highly effective team.

3. Contribute actively to new clinical program development through creation of training tools, resources, procedures, and workflows for providers and the client's coding auditors.

4. Educate, train, onboard, and communicate effectively with the team of providers on accurate, complete, and compliant documentation and coding practices and hold regular and episodic provider training initiatives.

5. Assess current compliance activities and evaluate risk factors in coding and documentation practices and implement strategies to mitigate risk by educating providers and coders.

6. Responsible for timely review of all billable encounters prior to claims submission for accuracy and completeness and comprehensive concurrent coding reviews and audits of a subset of encounters, with emphasis on documentation quality, accuracy, completeness, compliance, and specificity.

7. Establish, implement, and maintain a formalized review process for coding and documentation compliance, including a formal audit process and quality control.

8. Communicate with the providers in real time prior to claims submission or redaction through coding queries regarding need for clarification, amendment, or modification of specific patient encounters, following compliant practices to optimize documentation accuracy, specificity, and completeness.

9. Work with the provider team and center operations on timely closure of encounters and completion of tasks related to documentation and coding practices.

10.Oversee successful and timely bi-annual creation of redaction and submission Risk Adjustment Processing System (RAPS) files to the Center of Medicare and Medicaid Servicer (CMS).

Requirements

1. Education (Minimum level of education Preferred): Bachelor’s Degree in Health Information Management, Health Care Administration, Business Administration or equivalent combination of education and training. 
2. Certifications/Licenses Required: CA driver’s license with appropriate insurance coverage Active and current Certified Procedural Coder accreditation by an accredited organization or college, such as the AAPC, that meet the state licensure requirements, you will be required to maintain coding accreditation.
3. Experience Required (Minimum level of experience): 5 years of healthcare experience required; at least 3 years of management experience preferred. 3-5 years of hands-on professional coding experience in large multi-specialty group 2+ years of experience as a trainer / educator to physicians and coders
4. Verbal and Written Skills Required to perform the Job: Good written and verbal communication. Strong communication and presentation skills, preferably comfortable speaking with people at an executive level or physician level
5. Working Traits: Superb organizational ability and exceptionally analytical.
6. Technical Knowledge and Skills Required to Perform the Job: Experience and knowledge with Microsoft Office software.
7. Equipment Used: Company’s Laptop, occasionally personal phone. Working Conditions and Physical Requirements: Long Irregular hours. May work weekends. Prolonged periods of sitting, and constant walking and standing. Driving and occasional travel required.