REVENUE CYCLE CODING MANAGER - CODING QUALITY/EDUCATION

Job Summary

BASIC FUNCTION AND RESPONSIBILITY

The Outpatient Facility/Professional (OP/Pro) Coding Quality and Education Manager is responsible for accurate, and timely diagnosis and procedure coding, charge capture, and abstracting of all required data elements from the patient medical record. The Manager ensures the adherence to standards of ethical and compliant coding, Center of Medicare and Medicaid Services (CMS), AHA Official ICD-10-CM Coding Guidelines, CPT, and other regulatory standards. Develop, implement, and monitor policies, procedures, and systems for proper coding and reporting. The Manager is responsible for developing, implementing, and maintaining a quality management program to support improvement in coding completeness and accuracy. The manager reviews coding performance, provides performance metrics to appropriate managers, and ensures successful staff education.

This individual develops and maintains policies and procedures that will improve and support revenue cycle operations and organizational goals, as well as promote timely and accurate coding practices that comply with organizational policies, OIG guidelines, and other applicable regulations. Overall, the manager utilizes project management skills, clinical knowledge and understanding of documentation and coding requirements to improve processes and compliance.

The Manager will oversee the OP/Pro Medical Coder Compliance Specialists (MCCS), The PB Denials Team, and the Appeals and Denial Coordinators. These professionals support coding compliance, training, and continuing education.

What You'll Do

LEADERSHIP

• Analyze effectiveness of OP Facility/Professional coding operations to identify opportunities for process improvement using Lean and High Reliability methodologies to streamline processes and ensure the most efficient use of Revenue Cycle Coding resources to meet the needs of the organization.
• Monitor changes in laws, regulations and policies that impact coding and reimbursement and assure compliance with coding procedures and work flows.
• Assist the Director of OP Facility/Pro in the development, implementation and assessment of long range and short-term goals for the Coding Unit.
• Provide leadership representation on institutional committees as it relates to assigned units.
• Provide leadership for and actively participate in departmental and institutional activities and programs.
• Identify and address change management issues related to the evolution of the Revenue Cycle environment.

OPERATIONS

• Monitor daily progress of coding throughput and implement personnel and operational changes to address objectives.
• Monitor and report productivity and accuracy of coders, collect statistical data from the electronic health record (EHR) and coding systems, provide clarification and coaching to staff on coding expectations to assure the highest quality of coding in the timeliest and efficient manner.
• Plan and schedule work for the unit ensuring proper staffing and distribution of assignments to accomplish required tasks; plan and schedule meetings with staff to explain and implement new policies and procedures and practices.
• Oversee contract coding agency staff.
• Oversee the capture and analysis of data regarding operational performance.
• Participate in and demonstrate an understanding of the Michigan Quality System/Continuous Quality Improvement and apply Lean Thinking and High Reliability concepts in daily work
• Demonstrate initiative by continuous expansion of knowledge and skills
• Plan, develop, revise, and implement programs, policies and procedures for assigned units.
• Conduct regular staff meetings for a home-based workforce.
• Assess assigned operations and implement changes to work processes as needed.
• Support outside data abstraction processes used for quality improvement efforts and registries.
• Perform customer acceptance testing for software upgrades.
• Develop and coordinate educational and training programs regarding system upgrades and changes to Coding workflows.
• Actively participates in the evaluation, selection, and maintaining of information systems supporting coding.

COMPLIANCE PROGRAM

• Establishes, implements, and maintains a formalized review process for coding compliance, including a formal review (audit) process. Designs and uses audit tools to capture, monitor, and report the accuracy of ICD-10-CM, and CPT coding, modifier application, and other coded data elements.
• In partnership with the OP/Pro Coding leadership team, ensures compliance with the organization?s coding procedures and standards as well as third-party coding regulations such as, but not limited to, CMS, the Official Coding Guidelines for ICD-10, CPT, ASA, NCCI, LCD/NCD, and external regulatory and accreditation requirements.
• Establishes, maintains, and communicates standards and guidelines related to internal quality reviews, compliance initiatives, reporting initiatives, benchmarking, research and analysis, continuous improvement opportunities, strategic planning, or other requested projects in partnership with unit and departmental leadership.
• Assists coding leadership by making recommendations for process improvements to further enhance coding quality goals and outcomes.
• Creates, reviews, and updates the Revenue Cycle Coding Compliance Plan and program in response to changing organizational needs or new or revised regulations, policies, or guidelines and incorporate changes into audit practice.
• Develops and implements coding training plans within Revenue Cycle, including curriculum development, preparation and delivery of training to improve the accuracy, integrity and quality of patient coded data and to improve the quality of provider documentation within the body of the medical record to support code assignment.
• In coordination with others, provides education to clinical departments and impacted clinical leaders as requested on areas of coding.
• Conduct regular staff meetings for a home-based workforce.

PEOPLE AND PARTNERS

• Collaborate with clinical, administrative, and IT partners to resolve technical and process issues related to MiChart and Computer Assisted Coding installation & upgrades and business work flows to ensure compliant and timely coding and billing.
• Provide leadership for process improvement and redesign to improve customer satisfaction, reduce costs, and/or meet departmental and institutional goals and objectives.
• Develop and maintain professional relationships with colleagues and staff within the department and across the organization to promote mutual understanding and respect.
• Work within the department, across the organization, and with clinical and senior leadership to meet organizational goals.
• Demonstrates excellent customer service skills in working with staff, clinicians, and other staff at Michigan Medicine.
• Design requirements, criteria, and metrics to meet the end users? needs for analysis and interpretation of health information and statistics for Coding.

DATA ANALYSIS / REPORTING

• Actively engages in analysis of data, plans for improvement and re-measurement activities to assess performance improvement as dictated by quality program targets. Recommends corrective action and improvements to internal processes.
• Analyzes audit findings to identify trends and patterns, makes recommendations for additional focused audits, follows up actions and/or coder education and training as well as analyses of potential and actual financial risks.
• Monitors and evaluates the effectiveness of education and training programs and develops correction action plans based on key performance measures.
• Prepares comprehensive reports as requested by state or federal agencies or other regulatory agencies, and as directed by leadership.

CODING COMPLIANCE & EDUCATION

• Partner in developing strategy to address high-risk coding practices, recommendations for corrective action plans or process improvements and creates policies, procedures, and internal controls which reinforce the highest level of standard of coding quality goals and outcomes.
• Collaborate with Manager of Coding Compliance & Education to develop operational documentation and training materials for staff and to support coding quality and education initiatives.

COMPETENCIES

• Extensive knowledge of ICD-10 and CPT coding principles and guidelines.
• Extensive knowledge of federal, state, and payer-specific regulations and policies pertaining to documentation, coding, and billing.
• Complies with all aspects of coding, abides by all ethical standards, and adheres to official coding guidelines.
• Ability to work independently as well as with a diverse group of people in a diplomatic and effective manner.
• Strong customer focus and the knowledge and skill to identify, meet and evaluate customer expectations.
• Strong presentation skills.
• Exceptional ability to lead, manage, and mentor staff through complex work redesign efforts.
• Logical, analytical, and organized with the ability to reprioritize quickly and efficiently.
• Ability to work in a fast-paced environment under multiple pressures and deadlines.
• Excellent verbal and written communication skills up, down, and across the organization.
• Considerable experience with Windows computer environment and proficiency with Microsoft Office software.
• Ability to work independently, self-motivated and an ability to adapt to the changing healthcare environment.
• Excellent verbal and written communication skills, analytical thinking and problem solving skills with attention to detail are required.
• Proficiency in organizational skills and planning with an ability to juggle multiple priorities in a fast changing environment.
• Ability to navigate the EHR to identify documents for review to provide accurate capture of clinical information.
• Knowledge and understanding of third party payer, regulatory and accreditation requirements.
• Excellent collaboration, meeting facilitation, presentation, and communication skills
• Exceptional analytical and problem-solving ability, organizational skills, and attention to detail

Required Qualifications*

• A Bachelor's degree in Business, Health Information Management or other healthcare-related degree or equivalent combination of education and experience.
• Registered Health Information Technologist or Administrator (RHIT/RHIA) through the American Health Information Management Association (AHIMA), certification through the American Academy of Professional Coders as a CPC, or comparable combination of educational preparation and experience in managing health information or coding operations and providing effective leadership.
• Knowledge ICD-10 and CPT coding knowledge with a strong understanding of the AHA Official ICD-10 Coding Guidelines and how to apply them.
• Demonstrated customer focus and the knowledge and skill to identify, meet, and evaluate customer expectations. Broad customer service experience with patients, families, physicians, and executive leadership.
• Thorough knowledge and understanding of how health information is used throughout the organization for patient care, reimbursement, statistical analysis, research, and as the legal record.
• Skill and experience with influencing and facilitating clinician behavior change.
• Demonstrated leadership skills and training in leadership as well as knowledge of modern management and High Reliability principles, practices, and methods.
• Ability to lead, manage, and mentor staff through complex work redesign efforts.
• Logical, analytical, and organized with the ability to direct and reprioritize work quickly and efficiently.
• Ability to work in a fast-paced environment under multiple pressures and deadlines.
• Excellent verbal and written communication skills up, down, and across the organization.
• Knowledge of third party payer, regulatory, and accreditation requirements.
• Current membership in the AHIMA and/or AAPC.
• Considerable experience with Windows computer environment and proficiency with Microsoft Office applications.
• Excellent organizational, management, planning, interpersonal, written and oral communication skills.
• Experience and expertise in working with medical staff and medical staff leadership on documentation improvement opportunities.
• Experience in analysis of operations and re-design to improve quality and outcomes

Desired Qualifications*

• A Master's degree or equivalent combination of education and experience
• Experience with Epic EHR, computer-assisted-coding and 3M applications.
• Knowledge of hospital billing systems and ADT systems.
• Knowledge of University and departmental policies and procedures.

Modes of Work

Positions that are eligible for hybrid or mobile/remote work mode are at the discretion of the hiring department. Work agreements are reviewed annually at a minimum and are subject to change at any time, and for any reason, throughout the course of employment. Learn more about the work modes .

Additional Information

SUPERVISION RECEIVED

Direction is received from the Director of OP Facility/Professional Coding.

SUPERVISION EXERCISED

Functional and administrative supervision is exercised over PB Denial coders, MCCS, and other assigned staff.

Background Screening

Michigan Medicine conducts background screening and pre-employment drug testing on job candidates upon acceptance of a contingent job offer and may use a third party administrator to conduct background screenings. Background screenings are performed in compliance with the Fair Credit Report Act. Pre-employment drug testing applies to all selected candidates, including new or additional faculty and staff appointments, as well as transfers from other U-M campuses.

Application Deadline

Job openings are posted for a minimum of seven calendar days. The review and selection process may begin as early as the eighth day after posting. This opening may be removed from posting boards and filled anytime after the minimum posting period has ended.

U-M EEO/AA Statement

The University of Michigan is an equal opportunity/affirmative action employer.

Job Detail

Job Opening ID

253980

Working Title

REVENUE CYCLE CODING MANAGER - CODING QUALITY/EDUCATION

Job Title

Revenue Cycle Coding Mgr

Work Location

Michigan Medicine - Ann Arbor

Ann Arbor, MI

Modes of Work

Hybrid

Full/Part Time

Full-Time

Regular/Temporary

Regular

FLSA Status

Exempt

Organizational Group

Exec Vp Med Affairs

Department

MM Rev Cycle (PTO)

Posting Begin/End Date

9/09/2024 - 9/23/2024

Career Interest

Finance