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The Coding Supervisor is responsible for the coordination of all coding and related workflows. This includes general supervision of coders, reviews, and analyses EPIC OCHIN Work Queues to assure the final diagnoses and procedures as stated by the practicing providers are valid and complete. Accurately codes office procedures for providers to ensure proper reimbursement. Provides education to the providers to ensure proper completion of Electronic Health Records and proper assignment of ICD-10-CDM, HCPCS, and CPT codes. Work closely with the Revenue Cycle Manager and Denial Specialist to perform analytical reviews to understand denial reason and successful claims processing rates. The Coding Supervisor will report to the Revenue Cycle Manager.
Age/Patient Populations Served (Double-click on box to activate appropriate indicator)
Age of Patient Population Served
Pediatric (birth - 19 yrs)
Adult (19 – 64 yrs)
Geriatric (65 yrs & older)
Nonage Specific Task (N/A)
Population
Bariatric Patients: BMI greater than 40, or greater than 35 with weight related comorbidities
Patient with exceptional communication needs
Patient with developmental delays
Patient at the end of life
Patient under isolation precautions
All Populations
Essential Duties and Responsibilities
- Audits medical records to ensure proper coding completed and to ensure compliance with federal and state regulatory bodies and ensure proper submission of services prior to billing on pre-determined selected charges
- Monitors all relevant EPIC coding work queues daily, assigns work to Coders, and work collaboratively with the Biller Supervisor to ensure timely coding and billing.
- Continuously works to improve the revenue cycle process, maximize reimbursement, and makes recommendations for problem-solving as needed
- Confirm/provide correct ICD-10-CM diagnosis codes on all diagnoses provided
- Supplies correct HCPCS, CPT codes on all procedures and services performed
- Analyzes provider documentation to assure the appropriate Evaluation & Management (E&M) levels are assigned using the correct CPT code
- Determines the final diagnoses and procedures stated by the physician or other health care providers are valid and complete. Ensure that sequence of codes meets the criteria and established practice.
- Contact providers with questions about treatment or diagnostic tests with regard to coding procedures.
- Provide training and updates to clinical and billing staff regarding coding changes
- Work collaboratively with the billing department to ensure all claims are satisfied in a timely manner
- Accurately follows coding guidelines and legal requirements to ensure compliance with federal and state regulatory bodies
- Keep the manager informed regarding any billing issues, updates on charge entry, and AR in preparation for monthly operating meetings
- Attends seminars and in-services as required to remain current on coding issues
- Maintains compliance standards in accordance with the compliance policies and the Code of Conduct.
- Reports compliance problems appropriately working in close collaboration with the Compliance Officer and Performance Improvement Officer.
- Quantitative analysis - Performs a comprehensive review of the record to assure the presence of all component parts such as patient and record identification, signatures and dates where required, and all other necessary data in the presence of all reports which appear to be indicated by the nature of the treatment rendered.
- Qualitative analysis - Evaluates the record for documentation consistency and adequacy. Ensures that the final diagnosis accurately reflects the care and treatment rendered. Reviews the records for compliance with established reimbursement and special screening criteria.
- Performs other related duties, which may be inclusive, but not listed in the job description
PHMC Compliance Responsibilities:
- Understands and adheres to PHMC compliance standards as they appear in the PHMC Code of Conduct, Whistle Blowers, and Conflict of Interest Policies.
- Keeps abreast of all pertinent federal, state, and PHMC regulations, laws, and policies as they presently exist and as they change or are modified.
- Comply with HIPAA and Confidentiality Policies and Procedures as they apply to the job
- Comply with the Department of Public Health (DPH), The Joint Commission, and other accreditation and regulatory agencies standards.
- Adhere to all PHMC Policies and Procedures.
- Knowledge and adherence to Infection Control and Environment of Care Guidelines and Procedures as described in the annual education module.
JOB REQUIREMENTS:
To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below must be representative of the knowledge, skills, minimum education, training, licensure, experience, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions.
SKILLS:
- Excellent interpersonal skills
- Computer competency
- Proficient in utilizing all insurance payors' portals.
- Knowledge of federal laws and regulations affecting coding requirements
- Knowledge of principles, practices, and methods of current coding certificate required.
- Knowledge of billing practices required, FQHC billing preferred
- Knowledge of medical records, EHR required
- Extensive knowledge of official coding conventions and rules established by the American Medical Association (AMA), and the Center for Medicare and Medicaid Services (CMS) for assignment of diagnostic and procedural codes.
- Must have good math skills and effective communication skills.
- Perform coding work requiring independent judgment with speed and accuracy
- Examine and verify coding errors through audits
- Communicate clearly and concisely, orally and in writing
- Must have the ability to work independently to accomplish assigned work in a timely manner
EXPERIENCE:
- Two years plus of leadership/mentor and training experience
- Two years plus of progressive Health Information Management or Revenue Cycle Management experience
- Three years’ experience using ICD-9-CM, CPT, HCPCs or equivalency, and at least 1 year with ICD 10
- Proficient knowledge of medical billing and coding practices and procedures, preferably in a FQHC environment.
- Ability to process and maintain confidential matters and information.
- Knowledge of Allscripts EHR application or another EHR preferred.
EDUCATION:
- High School Diploma
- Medical Coding Certificate - RHIT or CPC certification is required
PHYSICAL DEMANDS:
Position requires standing 2/3 of the time, walking 2/3 of the time, requires sitting under 1/3 of the time, use of hands to finger, handle or feel 2/3 of the time, reaching with hands and arms, under 1/3 of the time, talking or hearing over 2/3 of the time.
WORK ENVIRONMENT:
Moderate noise
salary: Based on education and experience. Pay Grade - 18