How to apply: https://whallc.applicantpool.com/jobs/JOB SUMMARY:
Responsible for supervision of all facets of charge capture and coding, including charge review and coding related claim edits.
ESSENTIAL JOB FUNCTIONS:
- Ensures the timely and accurate capture of charges, and submission of clean claims.
- Ensures that physician documentation supports medical necessity and substantiates services provided.
- Leads and participates in ad hoc teams to improve coding and charge capture processes.
- Works collaboratively with audit and compliance teams to educate providers on the appropriateness of coding and billing compliance.
- Monitors coding denials to identify potential problem areas and takes prompt, effective action to ensure timely, appropriate reimbursement.
- Monitors work production and quality of coding and charge capture.
- Recommends the development of Epic Charge Router rules and Charge Review edits to ensure that charges are correct prior to billing.
- Monitors workflows and system-enhancement opportunities to optimize efficiency and effectiveness.
- Develops, maintains, and assures compliance with Policies and Procedures for the team.
- Obtains and maintains proficient level of knowledge (eg., Epic ARCR Certification) of applicable Epic tools to ensure continued enhancement to people, process and technology.
- Makes hiring recommendations and evaluates performance of direct reports.
- Coordinates staff schedules to assure adequate coverage to meet performance expectations.
- Works collaboratively with the rest of the management team to improve processes and meet goals.
- Responsible for employment and selection decisions. Completes and forwards employment requisitions for personnel replacements to Human Resources. Interview, checks references and makes hiring decisions for new employees in coordination with PFS Manager and Human Resources. Partners with PFS Manager and Human Resources to resolve compensation issues and determine starting pay for new hires.
- Recommends changes to policies and procedures as needed.
- Researches and arranges coding continuing education.
- Orders coding manuals and other resources annually and distributes to the administrative office and clinics.
- Takes responsibility for and demonstrates safe work practices.
- Maintains regular and predictable attendance.
- Maintains WHA confidentiality standards.
- Attends WHA and office meetings.
- Models The Values Statement and The Patient Experience of WHA.
- Ability to work independently in a multi-task environment.
- Ability to weight pros and cons of decisions and make sound recommendations.
- Strong customer service and interpersonal communication skills, both verbally and in writing. Ability to foster teamwork and communication in others and handle sensitive communications.
- Develops strong relationships with all departments to develop coding and reimbursement training materials and to receive feedback.
- Ability to solve difficult coding and reimbursement problems effectively, using empathy and tact.
- Ability to analyze problems and resolve independently or in collaboration with others.
- Knowledge of organizational policies, regulations and procedures to complete decisions independently.
- Ability to consistently present a professional image and positive attitude when dealing with clinicians and employees on coding and reimbursement issues.
- Ability to inspire and motivate clinicians and the patient accounts staff to perform at a high level of excellence in coding and auditing.
- Ability to consistently consider the effect of actions on others and the team goals.
- Ability to persist in dealing with insurance companies.
- Initiative to remain up to date on coding and insurance billing changes, reimbursement and collection laws and practices.
- Ability to conduct effective team meetings and manage on-going education for the team.
- Ability to supervise remote staff.
- Ability to prioritize workload and follow through on assignments.
- Demonstrates accountability and responsibility for own work and work of team.
- Ability to inspire and motivate the staff they lead to perform at a high level of excellence.
- Ability to be flexible in adapting to changing needs.
- Commitment to ongoing professional development.
- Participates and works with other Managers and Supervisors in developing good working relationships and processes throughout the Clinic.
SECONDARY JOB FUNCTIONS:
- May provide coverage in coding of surgeries during planned absences.
- Performs other tasks as assigned.
ESSENTIAL EQUIPMENT, TOOLS OR MACHINERY:
Personal computer, printer, telephone, facsimile machine, photocopier, 10-key.
Work is conducted in a well-lit, air-conditioned office environment. Considerable sitting required and ability to perform keyboarding motions. Ability to hear and to communicate well verbally. Color vision preferred and visual acuity required to observe personal computer monitors. Physical mobility to retrieve materials up to 15 pounds.
- High School diploma or GED required. Certification as Professional Coder (CPC) required, OB/GYN certification preferred.
- Experience with EPIC software preferred, ideally in an OB/GYN clinic.
- Minimum two years supervisory experience in a medical physician office facility.
- Minimum two years in medical practice billing, coding and collections.
- Advanced working knowledge of medical billing operations.
- Advanced and current knowledge of CPT, and ICD-10 coding.
- Current knowledge of insurance payer coding and reimbursement guidelines.
- Ability to identify, initiate, implement and manage business practices, policies and processes.
- Proficient organizational skills, attention to detail and accuracy.
- Demonstrated ability to establish and maintain effective working relationships with internal and external parties.
- Ability to exercise initiative, problem-solving and decision making.
- Excellent interpersonal and communication skills.
- Demonstrated customer service oriented attitude/behavior.
- Demonstrated success in service excellence and quality improvement.
- Valid driver’s license and the ability to drive to various WHA sites and meetings.
- Ability to demonstrate The Mission and Values and The Patient Experience of WHA.
- Ability to perform the essential functions of the job.
Women’s Healthcare Associates, LLC believes that each employee makes a significant contribution to our success. This position description is designed to outline primary duties and qualifications but not limit the employee or WHA to the work identified above.