Posting Details

Posting Details

Posting Number S12230P

Working Title Coding and Compliance Manager

Department UHC-Business Services

About the University of Georgia

Since our founding in 1785, the University of Georgia has operated as Georgia's oldest, most comprehensive, and most diversified institution of higher education (https://www.uga.edu/). The proof is in our more than 235 years of academic and professional achievements and our continual commitment to higher education. UGA is currently ranked among the top 20 public universities in U.S. News & World Report. The University's main campus is located in Athens, approximately 65 miles northeast of Atlanta, with extended campuses in Atlanta, Griffin, Gwinnett, and Tifton. UGA employs approximately 3,000 faculty and more than 7,700 full-time staff. The University's enrollment exceeds 40,000 students including over 30,000 undergraduates and over 10,000 graduate and professional students. Academic programs reside in 18 schools and colleges, as well as a medical partnership with Augusta University housed on the UGA Health Sciences Campus in Athens.

About the College/Unit/Department

College/Unit/Department website

Posting Type External

Retirement Plan TRS or ORP

Employment Type Employee

Benefits Eligibility Benefits Eligible

Full/Part time Full Time

Work Schedule

Additional Schedule Information

Monday - Friday 8:00am - 5:00 pm. Some evenings and weekends may be required.

Advertised Salary $62,000

Posting Date 06/12/2024

Open until filled No

Closing Date 06/17/2024

Proposed Starting Date 07/01/2024

Special Instructions to Applicants

Location of Vacancy Athens Area

EEO Policy Statement

The University of Georgia is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, ethnicity, age, genetic information, disability, gender identity, sexual orientation or protected veteran status. Persons needing accommodations or assistance with the accessibility of materials related to this search are encouraged to contact Central HR (hrweb@uga.edu).

USG Core Values Statement

The University System of Georgia is comprised of our 26 institutions of higher education and learning, as well the System Office. Our USG Statement of Core Values are Integrity, Excellence, Accountability, and Respect. These values serve as the foundation for all that we do as an organization, and each USG community member is responsible for demonstrating and upholding these standards. More details on the USG Statement of Core Values and Code of Conduct are available in USG Board Policy 8.2.18.1.2 and can be found on-line at https://www.usg.edu/policymanual/section8/C224/#p8.2.18_personnel_conduct. Additionally, USG supports Freedom of Expression as stated in Board Policy 6.5 Freedom of Expression and Academic Freedom found on-line at https://www.usg.edu/policymanual/section6/C2653.



Position Information

Classification Title Business Operations Professional

FLSA Exempt

FTE 1.00

Minimum Qualifications

Requires at least a baccalaureate degree in the field. Please contact your Human Resources office for an evaluation of education/experience in lieu of the required minimum qualifications.

Preferred Qualifications

UHC Minimum:

• Seven (7) years of experience in medical financial service operation.
• Bachelor's or Associate degree in English, Business Administration or other related field from an accredited college or university required.
• Certified Professional Coder (CPC) certification required, which includes staying current with AAPC (American Academy of Professional Coders) membership.

UHC Preferred:

• Certified Professional Medical Auditor (CPMA) certification preferred.

Position Summary

Reporting to the Assistant Director - Compliance & Business Services, the Coding and Compliance Manager oversees the day-to-day operations of UHC's coding, billing, and compliance audits. This includes managing the billing for all University Health Center insurance claims and ensuring the claims are filed accurately and timely in accordance with Medicare guidelines. Additionally, this position maintains policies and procedures for coding and coding guidelines. The Coding and Compliance Manager directly supervises two (2) Medical Billing Specialists.

Knowledge, Skills, Abilities and/or Competencies

• Strong customer service and communication skills, excellent verbal skills, computer skills (Microsoft Office), strong basic math skills and possess the ability to handle multiple tasks with flexibility and attention to detail.
• Understand all payers as it relates to billing and have the knowledge of payor reimbursement methodology.
• Competency with Electronic Medical Record (EMR) systems.
• Effectively and professionally communicate with other departments and co-workers to resolve coding and claim issues.

Physical Demands

• See objects closely, as in reading.
• Operate all equipment as needed.
• Sit for long periods of time (4-8 hours).
• Perform fine motor skills.

Is driving a responsibility of this position? No

Is this a Position of Trust? Yes

Does this position have operation, access, or control of financial resources? Yes

Does this position require a P-Card? No

Is having a P-Card an essential function of this position? No

Does this position have direct interaction or care of children under the age of 18 or direct patient care? Yes

Does this position have Security Access (e.g., public safety, IT security, personnel records, patient records, or access to chemicals and medications) Yes

Credit and P-Card policy

Be advised a credit check will be required for all positions with financial responsibilities. For additional information about the credit check criteria, visit the UGA Credit Background Check website.

Background Investigation Policy

Offers of employment are contingent upon completion of a background investigation including, a criminal background check demonstrating your eligibility for employment with the University of Georgia; confirmation of the credentials and employment history reflected in your application materials (including reference checks) as they relate to the job-based requirements of the position applied for; and, if applicable, a satisfactory credit check. You may also be subject to a pre-employment drug test for positions with high-risk responsibilities, if applicable. Please visit the UGA Background Check website.



Duties/Responsibilities

Duties/Responsibilities

Coding, Billing and Documentation Compliance:

• Audits the accuracy and completeness of diagnosis and procedure coding.
• Identify incomplete documentation in the medical record and formulates a clinician query to obtain missing documentation and/or clarification to accurately complete the coding process.
• Prepares periodic reports for clinical staff identifying unbilled charges due to inadequate documentation.
• Stay abreast of relevant billing and coding questions concerning the current calendar year.
• Maintaining policies and procedures for coding and coding guidelines.
• Provides input and guidance in the development and review of detailed audit programs and reports to improve audit effectiveness and efficiency. Compliance and Regulatory guidelines include: Fraud and Abuse, Federal False Claims Act, Anti-Kickback Law, Stark Law, Exclusion Statute, Civil Monetary Penalties Law, Office of Inspector General (OIG), Centers for Medicare and Medicaid Services (CMS).
• Advises and instructs coders/providers regarding billing and documentation policies, procedures, and regulations. Interacts with providers regarding conflicting, ambiguous, or non-specific medical documentation, to obtain clarification. Proficient in organizing and compiling documentation and thoughts in order to provide supported opinions to the medical providers on audit findings.
• Manages the collection of data to be used for analytics (i.e., statistical sampling, identification of trends). Shares this data with directors and billing providers as a part of utilization review.

Percentage of time 40 Duties/Responsibilities

Oversight of Delayed Payments by Insurance Carries:

• Manages the processes for researching, analyzing, and monitors unpaid claims when identifying lost revenue through inadequate coding, unbilled services, and incorrect reimbursements.
• Oversees the correspondences with insurance carriers regarding claims greater than 90 days old.
• Manages the appeals process for any claims to insurance carriers that is denied as untimely.
• Corresponds with patient and/or family member regarding insurance and appeals non-payment claims to the insurance company when appropriate.

Percentage of time 30 Duties/Responsibilities

Oversight of Preparing and Submitting Claims for Insurance Reimbursement:

• Oversees the processing of all electronic claims through our third-party clearing house and the preparing/mailing out any paper claims that can't be filed electronically, including Dental.
• Monitors clearing-house reports of rejected claims and helps develop measures to minimize future rejections.
• Responds to billings inquiries by e-mail, fax, Instant Messaging and phone according to departmental policies.
• Manages all Motor Vehicle Accident claims.

Percentage of time 20 Duties/Responsibilities

Leadership and Staff Supervision:

• Directly supervises two (2) full-time staff members.
• Actively participates in and promotes the engagement, development, and retention of each staff member.
• Conducts performance appraisals on direct reports on a timely basis, provide feedback which recognizes professional achievements, encourages professional growth, and determine appropriate merit increases.
• Participates in annual staff development programming, annual training and fosters service excellence programs.
• Empowers staff to optimize use of their expertise, collaborate, and ensure continuing education, career growth and retention.

Percentage of time 10

Contact Information

Recruitment Contact

Contact Details

For questions concerning this position or recruitment progression, please refer to the Recruitment Contact listed below.

Recruitment Contact Name Shannon KuyKendall

Recruitment Contact Email march30@uga.edu

Recruitment Contact Phone



Posting Specific Questions

Required fields are indicated with an asterisk (*). Applicant Documents Required Documents

1. Resume/CV
2. Cover Letter
3. List of References with Contact Information

Optional Documents

1. Other Documents #1